Nutrition Alert Form (NAF) as a Screening Tool for Predicting Malnutrition Risk in Outpatients with Cirrhosis: A Cross-Sectional Study
Manon Mitpracha¹, Chanita Unhapipatpong², Nint Polruang³, Narachai Julanon⁴, Thanachai Panaput⁵, Kittithat Taemkaew⁶
Affiliation : ¹ Division of Gastroenterology and Hepatology, Department of Medicine, Khon Kaen Hospital, Khon Kaen, Thailand; ² Division of Clinical Nutrition, Department of Medicine, Khon Kaen Hospital, Khon Kaen, Thailand; ³ Department of Pharmacy, Khon Kaen Hospital, Khon Kaen, Thailand; ⁴ Division of Dermatology, Department of Medicine, Khon Kaen University, Khon Kaen, Thailand; ⁵ Division of Nephrology, Department of Medicine, Khon Kaen Hospital, Khon Kaen, Thailand; ⁶ Clinical Nutrition and Obesity Medicine Unit, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
Background: Malnutrition is common among cirrhotic patients, leading to increased morbidity and mortality. Validated screening tools are essential for the early identification of malnutrition risk, enabling timely nutritional assessment and intervention.
Objective: To validate the Nutrition Alert Form (NAF) against the Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) in outpatients with cirrhosis, explore the relationship between NAF scores and anthropometric parameters, and evaluate the NAF’s diagnostic performance using the Global Leadership Initiative on Malnutrition (GLIM) criteria.
Materials and Methods: The authors conducted a cross-sectional study that included 179 randomly selected cirrhotic outpatients. Various nutrition screening and assessment tools were employed, along with anthropometric measurements and biochemical tests. The NAF encompasses patient-directed questions, body weight, and body mass index (BMI). Alternatively, total lymphocyte count (TLC), or serum albumin (ALB) could replace weight and height when they were unavailable.
Results: Approximately 43% of patients were identified as being at risk for malnutrition by the RFH-NPT, while the NAF-BMI, NAF-TLC, and NAF-ALB identified 41.9%, 46.9%, and 46.3% of patients, respectively. Using GLIM criteria, the prevalence of malnutrition was 18.4%. The NAF-BMI, NAF-ALB, and NAF-TLC showed sensitivities of 93.9%, 96.9%, and 93.9%, with specificities of 69.9%, 65.1%, and 63.7%, respectively. The RFH-NPT exhibited a sensitivity of 90.9% and specificity of 66.4%. A strong correlation (ρ=0.75, p<0.05) was observed between the RFH-NPT and NAF-BMI scores. NAF-BMI scores moderately correlated with cirrhosis severity (ρ=0.41, p<0.05). Screening completion times did not differ significantly between methods.
Conclusion: Due to its high sensitivity and accuracy, the NAF can serve as a simple and validated tool to screen for risk of malnutrition in cirrhotic patients. It also correlated with the RFH-NPT.
Received 6 February 2024 | Revised 28 April 2024 | Accepted 14 May 2024
DOI:10.35755/jmedassocthai.2024.7.14002
Keywords : Nutrition Alert Form; Cirrhosis; Malnutrition; Royal Free Hospital-Nutritional Prioritizing Tool; Global Leadership Initiative on Malnutrition
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