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

Background
Malnutrition is a common complication in patients with chronic diseases, often exacerbated by clinical factors and increased metabolic demands. In individuals affected by Decompensated Chronic Liver Disease (DCLD), fluid retention, such as oedema and ascites, can hinder accurate nutritional assessment, leading to underdiagnosis or misdiagnosis of weight loss and malnutrition. The present study describes the development and validation of a novel tool for Systematic Nutritional Clinical Assessment (SyNCA), including its content, semantic, and construct validity.

Methods
In Phase 1, the Delphi protocol was employed to evaluate SyNCA content and semantic validity with input from clinical nutrition experts and resident nutritionists. Phase 2 involved a cross-sectional, multicentre study of DCLD hospitalised patients to assess construct validity. SyNCA outcomes were compared with established nutritional assessment methods including anthropometry, handgrip strength (HGS), and dual-energy X-ray absorptiometry (DEXA). Correlations were analysed using Pearson or Spearman coefficients.

Results
Following expert review in Phase 1, out of the 18 items initially proposed across five anatomical regions, 14 items were retained in the final SyNCA instrument. In Phase 2, data from 136 hospitalised DCLD patients revealed moderate correlations between SyNCA scores and arm muscle circumference (r = −0.567, p < 0.0001), HGS (r = −0.376, p < 0.0001), and Appendicular Muscle Mass Index (r = −0.502, p < 0.001), supporting construct validity.

Conclusion
SyNCA demonstrated strong content, semantic, and construct validity, demonstrating its potential as a reliable clinical tool for nutritional assessment in DCLD hospitalised patients, and particularly welcomed in clinical settings with limited resources or where traditional methods are impractical.

Summary

The presence of oedema and ascites impairs nutritional assessment due to fluid retention, leading to the underdiagnosis of malnutrition and weight loss in affected patients.

We developed and undertook content and semantic validation using the Delphi protocol (Phase 1), and construct validation (Phase 2), of a low-cost instrument for Systematic Nutritional Clinical Assessment (SyNCA).

Phase 2 was a multicentre study involving 136 patients with decompensated chronic liver disease, assessed using SyNCA, anthropometry, Handgrip Strength (HGS), and Dual-Energy X-ray Absorptiometry.

SyNCA demonstrated strong content and semantic validity, alongside moderate correlations between its scores and mid-upper arm muscle circumference, HGS, and Appendicular Skeletal Muscle Mass Index.

SyNCA may serve as a reliable clinical tool for nutritional assessment of hospital inpatients, particularly in resource-limited settings or where traditional objective methods are unfeasible or prohibitively costly.