Malnutrition is a risk factor in patients with chronic liver disease. Poor nutritional status also increases perioperative mortality and morbidity during transplantation and abdominal surgery. However, the prevalence of protein-calorie malnutrition (PCM) in this population has varied between 10 percent and 100 percent in different studies. Only one present study has defined the prevalence and characteristics of malnutrition and its relationship with nutritional status and the severity of liver disease. Therefore, the goals of the present study were to determine the prevalence of PCM characteristics, and clinical importance of nutrition disorders in patients with liver cirrhosis according to the severity of the disease.
Sixty Thai patients with cirrhosis, who attended an out-patient clinic in Bangkok, Thailand, were included in this study. Child-Pugh criteria were used to establish the severity of liver disease. Nutritional assessments, including a 24-hour recall, were performed on all subjects by an experienced nutritionist. Skinfold thicknesses and immunocompetency (through normal or abnormal response to skin tests) were also recorded. Blood was collected to test for liver and renal function, prealbumin, and thiamine and riboflavin levels.
In terms of energy malnutrition, 13.3 percent of patients had ideal body weights below 90 percent and 11.7 percent had body mass indexes below 18.5 kg/sq m. Protein malnutrition (seen by low albumin stores) and immunoincompetence were found much more frequently than energy malnutrition, 45 percent and 22 percent, respectively. The origin of liver disease was alcohol related in 50 percent of patients. Most cases of nonalcoholic cirrhosis were caused by viral hepatitis. Fat mass in the alcoholic group was significantly lower than in the nonalcoholic group. There were fixe patients with thiamin deficiency, three were in the alcoholic group, and 13 patients with riboflavin deficiency, seven of those being in the alcoholic group. Serum protein directly correlated with the degree of liver-function impairment, but immunologic tests correlated inversely in cirrhosis patients.
The results showed that protein-energy malnutrition is a common complication of liver cirrhosis and that nutritional disorders are related to the degree of liver injury. The authors also acknowledge that the prevalence of PCM might be underestimated in this study. When body weight and BMI are used, these measures tend to be overestimated in cirrhotic patients because of fluid overload. This would then cause the prevalence of PCM to be underestimated. It is also clear from this study that the nutritional disorders were more severe with alcoholic cirrhosis than with nonalcoholic liver disease. This data is important so that medical professionals treating these patients have a better understanding of the characteristics of the disorder.
Chulaporn Roongpisuthipong, Aphasnee Sobhonslidsuk, Kanokrat Nantiruj, and Sriwatana Songchitsomboon. Nutritional assessment in various stages of liver cirrhosis. Nutrition 17: 761-765 (September 2001) [Correspondence to: Chulaporn Roongpisuthipong, MD, Department of Medicine, Ramathibodi Hospital, Faculty of Medicine, Mahidol University, Rama VI Road, Bangkok 10400, Thailand. E-mail: racrp@mahidol.ac.th.]
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