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Systematic Nutritional Clinical Assessment (SyNCA): Instrument Development, Delphi Protocol for Content, and Semantic

Rosangela Passos de Jesus1, Lucivalda Pereira Magalhães de Oliveira1, Carla de Magalhães Cunha1

  • 1Graduate Program in Food, Nutrition, and Health, School of Nutrition, Federal University of Bahia, Salvador, Bahia, Brazil.

Journal of Human Nutrition and Dietetics : the Official Journal of the British Dietetic Association
|March 24, 2026
PubMed
Summary
This summary is machine-generated.

A new tool, Systematic Nutritional Clinical Assessment (SyNCA), accurately assesses malnutrition in decompensated chronic liver disease patients. SyNCA offers a reliable method for nutritional evaluation, especially when traditional assessments are difficult.

Keywords:
chronic diseasesmalnutritionnutritional assessmentnutrition‐focused physical examinationsubjective methods

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Area of Science:

  • Clinical Nutrition
  • Medical Assessment Tools

Background:

  • Malnutrition is prevalent in chronic diseases, complicated by factors like fluid retention in Decompensated Chronic Liver Disease (DCLD).
  • Fluid overload in DCLD patients (oedema, ascites) impedes accurate nutritional status assessment, risking malnutrition underdiagnosis.
  • Traditional nutritional assessment methods face challenges in DCLD patients due to fluid retention.

Purpose of the Study:

  • To develop and validate a novel tool, Systematic Nutritional Clinical Assessment (SyNCA), for nutritional assessment in hospitalized DCLD patients.
  • To evaluate the content, semantic, and construct validity of the SyNCA tool.

Main Methods:

  • Phase 1: Delphi protocol with nutrition experts to establish SyNCA content and semantic validity.
  • Phase 2: Cross-sectional, multicentre study of 136 hospitalized DCLD patients to assess construct validity.
  • Comparison of SyNCA outcomes with anthropometry, handgrip strength (HGS), and dual-energy X-ray absorptiometry (DEXA).

Main Results:

  • The final SyNCA instrument comprised 14 items after expert review.
  • SyNCA scores showed moderate correlations with arm muscle circumference (r=-0.567), HGS (r=-0.376), and Appendicular Muscle Mass Index (r=-0.502).
  • These correlations support the construct validity of the SyNCA tool in DCLD patients.

Conclusions:

  • SyNCA demonstrates robust content, semantic, and construct validity.
  • The SyNCA tool is a reliable clinical instrument for nutritional assessment in hospitalized DCLD patients.
  • SyNCA is particularly valuable in resource-limited settings or when traditional methods are impractical.