Does protein energy malnutrition affect the outcome in Tunisian cirrhotic patients?

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Published Jul 29, 2016
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Vol. 94 No. 2 (2016): Issue Feb 2016

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Rym Ennaifer
Service de Gastro-entérologie Hôpital H. Thameur Tunis
Myriam Cheikh
Haifa Romdhane
Safa Sabbagh
Houda Ben Nejma
Wassila Bougassas
Najet Bel Hadj

Abstract

Abstract
Background: Malnutrition is commonly seen in cirrhotic patients and has been shown to adversely affect outcome. However, it remains associated with the severity of cirrhosis. Therefore, its role as an independent prognostAbstract
Background: Malnutrition is commonly seen in cirrhotic patients and has been shown to adversely affect outcome. However, it remains associated with the severity of cirrhosis. Therefore, its role as an independent prognostic factor is still under debate. The aims of our study were to determine the prevalence of malnutrition in cirrhotic patients and determine whether this condition was an independent prognostic factor.
Patients and methods: We prospectively analyzed the nutritional status of 104 consecutive patients with cirrhosis Subjective global nutritional assessment (SGA) and anthropometry [dry body mass index (BMI), triceps skinfold (TSF), arm muscle circumference (AMC)] were used for the evaluation of the nutritional status. Complications of cirrhosis during follow-up and patient's survival were recorded. Global survival and survival without complications was studied by Kaplan Meier method and using Log Rank test.
Results: Prevalence of malnutrition ranged from 16.3 and 62.5% according to the method of nutritional assessment used. Survival without complications was reduced in malnourished patients. This difference was significant when assessing malnutrition by dry BMI (p=0.001). In multivariate analysis, malnutrition defined by dry BMI<18.5 kg/m2 was an independent predictor of complications (p<0.001; RR 3.2) especially hepatic encephalopathy (p=0.001; RR 2.66). In univariate analysis, global survival was worse in malnourished patients (by BMI and SGA; p=0.03 and p=0.0014 respectively), but this trend was lost in multivariate analysis.
Conclusion: In our study, malnutrition was an independent predictor of complications in cirrhosis. However, it did not appear as an independent prognostic factor for global survival. These results raise again difficulties to clarify whether malnutrition influence itself the prognosis of cirrhosis or if it is only related to the severity of cirrhosis. 

Keywords:

Cirrhosis- Malnutrition- Anthropometry- Prognosis

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References

  1. Hébuterne X. Assistance nutritionnelle au cours des insuffisances hépatocellulaires. EMC (Elsevier Paris), Hépatologie, 7-034-D-90,2006
  2. Buyse S, Durand F, Joly F. Evaluation de l'état nutritionnel au cours de la cirrhose.Gastroenterol Clin Biol.2008;32:265-73.
  3. Plauth M, Merli M, Kondrup J, Weimann A, Ferenci P, Muller MJ. ESPEN guidelines for nutrition in liver disease and transplantation. ClinNutr. 1997;16:43-55
  4. Henkel AS, Bushman AL. Nutritional support in patients with chronic liver disease. Nat ClinPractGastroenterolHepatol. 2006;3:202-9.
  5. Bunout D, Aicardi V, Hirsch S, Petermann M, Kelly M, Silva Get al .Nutritional support in hospitalized patients with alcoholic liver disease. Eur J Nutr. 1989;43:615-21.
  6. Diehel AM, Boinott JK, Herlong HF, Potter JJ, Van Duyn MA, Chandler Eet al. Effect of parenteral aminoacid supplementation in alcoholic hepatitis. Hepatology. 1985;5:57-63.
  7. Bragança AC, Alvares-da-Silva MR. Prevalence of diabetes mellitus and impaired glucose tolerance in patients with decompensated cirrhosis being evaluated for liver transplantation: the utility of oral glucose tolerance test. ArqGastroenterol. 2010;47:22-7.
  8. Jones JM. Reliability of nutritional screening and assessment tools. Nutrition 2004;20:307-11.
  9. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000;894:1-253.
  10. Physician status: the use and interpretation of antropometry. Report of a WHO Expert Committee. World Health Organ Tech Rep Ser. 1995;854:1-452.
  11. Frisancho AR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J ClinNutr.1981;34:2540-5.
  12. Detsky AS, Mclaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA et al. What is Subjective Global Assessment of nutritional status? J Parenter Enteral Nutr. 1987;11:8-13.
  13. Huisman EJ, Trip EJ, Siersema PD, Van Hoek B, Van Erpecum KJ. Protein energy malnutrition predicts complications in liver cirrhosis. Eur J GastroenterolHepatol. 2011;23:982-9.
  14. Singal AK, Charlton MR. Nutrition in alcoholic liver disease. Clin Liver Dis. 2012;16:805-26.
  15. Lautz HU, Selberg O, Korber J, Burger M, Muller M. Protein calorie malnutrition in liver cirrhosis. ClinInvestig. 1992;70:478-86.
  16. Merli M, Giusto M, Gentili F, Novelli G, Ferretti G, Riggio O et al. Nutritional status: its influence on the outcome of patients undergoing liver transplantation. Liver Int. 2010;30:208-14.
  17. Soros P, Bottcher J, Weissenborn K, Selberg O, Muller MJ. Malnutrition and hypermetabolism are not risk factors for the presence of hepatic encephalopathy: a cross sectional study. J Gastroenterol Hepatol. 2008;23:606-10.
  18. Klaitzakis E, Olsson R, Henfridsson P, Hugosson I, Bengtsson M, Jalan R et al. Malnutrition and diabetes mellitus are related to hepatic encephalopathy in patients with liver cirrhosis. Liver int. 2007;27:1194-201.
  19. Merli M, Riggio O, Dally L. Does malnutrition affect survival in cirrhosis? PINC (PolicentricaItalianaNutrizioneCirrosi). Hepatology. 1996;23:1041-6.
  20. Alberino F, Gatta A, Amidio P, Merkel C, Di Pascoli L, Boffo G et al. Nutrition and survival in patients with liver cirrhosis. Nutrition. 2001;17:445-50.
  21. Moller S, Bendsten F, Christensen E, Henriksen H. Prognostic variables in patients with cirrhosis and oesophageal varices without prior bleeding. J Hepatol. 1994;21:940-6.
  22. AbadLacruz A, Cabre E, Gonzales- Huix F, Fernandez-Banares F, Esteve M, Planas R et al. Routine tests of renal function, alcoholism and nutrition improve the prognostic accuracy of Child-Pugh score in non-bleeding advanced cirrhotics. Am J Gastroenterol. 1993;88:382-7.
  23. Mendenhall CL, Moritz TE, Roselle GA. A study of oral nutritional support with oxandrolone in malnourished patients with alcoholic hepatitis: results of a department of veterans affairs cooperative study. Hepatology. 1993;17:564-76.
  24. Sasidharan M, Nistala S, Narendhran RT, Murugesh M, Bhatia SJ, Rathi PM. Nutritional status and prognosis in cirrhotic patients. Trop Gastroenterol.2012;33:257-64.