Evaluation of nutritional status in patients with liver cirrhosis

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Fatma Houissa
Mohamed Salem
Radhouan Debbeche
Leila Mouelhi
Slim Bouzaidi
Majd Ben Rejeb
Haiffa Mekki
Amel Moussa
Yosra Said
Senda Trabelsi
Taoufik Najjar

Abstract

Background: Malnutrition is a frequently reported complication in patients with liver cirrhosis. It has a high clinical and economic impact reflected by an increased morbidity and prolonged hospital stay.
Aim :This preliminary prospective study aimed to determine the prevalence of malnutrition in hospitalized cirrhotic patients and to investigate whether biological and anthropometric parameters are a valuable tool for identifying malnutrition in these patients.
Methods: The nutritional status of 44 consecutive cirrhotic patients (21 men, 23 women) was assessed according to the anthropometric measurements and biochemical analysis. The diagnosis of malnutrition was based on diminished values of Mid arm muscle circumference (MAMC) and/or Triceps skinfold thikness (TST) below the 5th percentile or less than 60%.
Results: The aetiology of cirrhosis was viral hepatitis in 29 patients (66%). Cirrhosis was classified Child Pugh A, B or C in respectively9, 26 and 9 patients; 37 patients (84%) have mild or tense ascite. In this study, malnutrition was found in 35 patients (79.5%), whereas 9 patients has a good nutritional status. TST and MAMC less than 60% was found in respectively 72% and 25% of patients. No significant statistical difference in epidemiological characteristics was found between malnourished and well-nourished patients. TST and MAMC decreased significantly according to the Child score (p= 0.014 and 0.032 respectively; a positive correlation was found between these two parameters and the severity of cirrhosis.
Conclusion: In this study, the high prevalence of denutrition was associated with the severity of cirrhosis. Anthropometric parameters are valuable tools for malnutrition diagnosis.

Keywords:

Malnutrition, Anthropometric parameters, Cirrhosis

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References

  1. Martineau J, D; Bauer J, Isenring E, Cohen S. Malnutrition determined by the patient-generated subjective global assessement is associated with poor outcomes in acute strocke patients. Clin Nutr 2005;24:1073-7.
  2. Normana K, Schütza T, Kemps M, Lübke HJ, Lochs H, Pirlich M. The Subjective Global Assessment reliably identifies malnutritionrelated muscle dysfunction. Clin Nutr 2005;24:143-50.
  3. O'Flynn J, Peake H, Hickson M, Foster D, Frost G.The prevalence of malnutrition in hospitals can be reduced: Results from three consecutive cross-sectional studies. Clinical Nutrition 2005;24:1078-88.
  4. Pirlich M, Schütz T, Norman K, Gastell S, Lübke HJ, Bischoff S, et al.The German hospital malnutrition study. Clinical Nutrition 2006;25:563-72.
  5. Campillo B, Richardet JP, Bories PN. Validation de l'indice de masse corporelle pour le dépistage de la dénutrition chez le malade cirrhotique Gastroenterol Clin Biol 2006;30:1137-1143
  6. Hasselmann M, Alix E. Outils et procédures de dépistage de la dénutrition et de son risque en milieu hospitalier. Nutr clin métabol 2003 ;17 :218-26.
  7. Sien-Sing Y, Chi-Hwa W, Li-Lin C, San-Chu M, Der-Fang C. Nutritional status in non-alcoholic sub-clinical porto-systemic encephalopathy. WJG 1998;4:380-4.
  8. Riggio O, Angeloni S, Ciuffa L, Nicolini G, Attili Af, Albanese C, Merli M. Malnutrition is not related to alterations in energy balance in patients with stable liver cirrhosis. Clinical Nutrition 2003 ;22:553-9.
  9. Elia M, Zellipour L, Stratton RJ. To screen or not to screen for adult malnutrition?. Clinical Nutrition 2005;24:867-84.
  10. Regina Caly W, Strauss E, Carrilho FJ, Laudanna A. Different degrees of malnutrition and immunological alterations according to the aetiology of cirrhosis: a prospective and sequential study. Nutrition Journal 2003 ; 2:1-9.
  11. Isabel M, Correia D, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and cost evaluated through a multivariate model analysis. Clin Nutr 2003;22:235-9.
  12. Lieber CS. Alcohol and the liver: 1994 update. Gastroenterology 1994;106:1085-105.
  13. Norman K, Kirchner H, Lochs H, Pirlich M. Malnutrition affects quality of life in gastroenterology patients. World J Gastroenterol 2006;12:3380-5.