Development of a liver cirrhosis-specific nutrition-focused physical examination tool: A modified Delphi study

Malnutrition in the form of protein-energy deficits and altered micronutrient status is associated with liver cirrhosis (LC). The study aimed to identify physical findings associated with malnutrition in adult patients with LC and to develop an LC-specific nutrition-focused physical exam (LC-specific NFPE) tool.

A modified Delphi approach was used to obtain consensus among expert panelists who were registered dietitians (RD) working in hepatology, gastrointestinal, transplantation, or other specialized settings treating patients with liver disease. Panelists were recruited through purposive sampling. Each panelist completed a 2-round online survey by scoring potential NFPE components on a 5-point Likert scale and providing optional open-ended feedback.

Panelists (N = 16) were ≥25 years of age, 93.75% had a Masters' degree or higher, and 100% reported using NFPE in practice. The 8 NFPE domains that achieved consensus were identified through an evidence-based literature search and include Anthropometrics, Vital Signs, Musculoskeletal and Adipose Exam, Orofacial Exam, Hair, Skin, and Nails Exam, Gastrointestinal Exam, Nervous System Exam, and Disease-specific Exam. Out of 63 initial components, 56 achieved consensus and were included in the LC-specific NFPE tool.

Specific domains and components for an evidence-based LC-specific NFPE tool were identified by obtaining consensus from a panel of expert RDs. This tool may further be developed and validated to assist in comprehensive nutritional assessment of patients with LC.