Elsevier

Nutrition

Volume 17, Issue 9, September 2001, Pages 761-765
Nutrition

PENSA meeting
Nutritional assessment in various stages of liver cirrhosis

https://doi.org/10.1016/S0899-9007(01)00626-8Get rights and content

Abstract

OBJECTIVES: The aims of this study were to determine the prevalence of protein-calorie malnutrition, characteristics, and clinical importance of nutrition disorders in patients with liver cirrhosis according to severity of disease.

METHODS: Nutrition assessments such as subjective global assessment, anthropometric and biochemical measurements, immunocompentency, thiamin and riboflavin status in 60 patients with cirrhosis (33 male and 27 female) were recorded between June 1999 and December 1999 at an outpatient clinic at Ramathibodi Hospital, Bangkok, Thailand. The origin of liver disease was alcohol related in 50% of patients. Child-Pugh criteria were used to establish the severity of liver disease.

RESULTS: In terms of energy malnutrition, 13.3% of patients had ideal body weights below 90% and 11.7% had body mass indexes below 18.5 kg/m2. Protein malnutrition (low albumin) and immunoincompetence (abnormal response to skin tests) were found much more frequently (45% and 22%) than energy malnutrition. Patients with alcoholic cirrhosis had ascites (P < 0.05) and hepatic encephalopathy (P < 0.001) more frequently and less triceps skinfold thickness than those with non-alcoholic cirrhosis. Subjective global assessment and serum proteins correlated with the degree of liver-function impairment, but immunologic tests correlated inversely in cirrhosis patients. Mean values for creatinine-height index, hemoglobin, cholesterol, and complement C4 showed significant decreases in severe liver failure (Child-Pugh class C) only in patients with alcoholic cirrhosis (P < 0.05). Malnutrition was correlated with the clinical severity of liver disease.

CONCLUSIONS: The study showed that protein-energy malnutrition is a common complication of liver cirrhosis. Nutritional disorders appeared to be related to the degree of liver injury and the etiology of nutritional disorders. Nutritional disorders were more severe with alcoholic cirrhosis than with non-alcoholic cirrhosis.

Introduction

Since the beginning of medical history, physicians and scientists including Hippocrates had noted that the prognosis for recovering from acute and chronic diseases was poorer in persons with lean and slender bodies than in those who were well nourished. Thus, nutrition assessment had its origin as a series of empirical clinical observations and estimations of nutritional status, which correlated with the ultimate results of diagnostic and therapeutic endeavors.

The prevalence of protein-calorie malnutrition (PCM) in chronic liver disease from previous studies ranges between 10% and 100%.1, 2 Malnutrition has been found to be a risk factor in those patients. Poor nutritional status increases perioperative mortality and morbidity during transplantation and abdominal surgery.3, 4 However, some studies have shown that nutrition support can improve liver function and survival in a select subgroup of patients with alcoholic liver disease.5, 6, 7 Only one Western study has defined the prevalence and characteristics of malnutrition and the correlation of nutritional status with the severity of liver impairment. Nutritional status in patients with alcoholic cirrhosis and virus-related cirrhosis has been compared by anthropometric, visceral protein, and immunologic values.8

The aims of our study were to 1) determine the prevalence of malnutrition in Thai cirrhotic patients; 2) evaluate nutritional status in various stages of liver cirrhosis by subjective global assessment (SGA), anthropometrics, biochemical data, immunologic aspects, and vitamin status; and 3) compare nutrition disorders associated with alcoholic and non-alcoholic cirrhosis.

Section snippets

Subjects

This cross-sectional analytical study was conducted between June 1, 1999 and December 31, 1999 at the outpatient clinic in the Department of Medicine, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Bangkok, Thailand. All patients provided written informed consent. Sixty patients with underlying cirrhosis were diagnosed on the basis of cutaneous stigmata of chronic liver disease, suggestive biochemical tests, and at least one of the following criteria: esophageal or gastric

Results

The prevalence of PCM in Thai patients with liver cirrhosis is shown in Table I. Body weight that was less than 90% of the ideal body weight (IBW) was found in 13.3% of cases, and a body mass index (BMI) below 18.5 kg/m2 was found in 11.7%. Triceps skinfold thickness 10 percentiles below the standard value was found in 30% of the study population. SGAs of moderate and severe PCM were 30% and 5%, respectively. Visceral protein levels of low serum albumin and prealbumin were 45% and 80%

Discussion

Malnutrition frequently occurs in patients with chronic liver disease and can influence their short- and long-term survival. Previously published data generally concern alcoholic patients. There are few data on the prevalence of nutritional abnormalities in patients with non-alcoholic cirrhosis.15, 16, 17

Patients with cirrhosis exhibited a wide range of nutritional abnormalities. In terms of energy malnutrition, 13.3% of patients had IBWs below 90% and 11.7% had BMIs below 18.5 kg/m2. Protein

Acknowledgements

The authors are grateful to Ms. Swairin Kulapongse, Kaekai Sumalnop, and Nanta Bussagorn for technical assistance and for help with statistical analysis. The authors thank Ms. Anongluk Rattano and Anurak Khanthom for preparing the manuscript.

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