Evaluation of the nutritional status of patients with liver cirrhosis

Barbara Janota; Aneta Krupowicz; Kinga Noras; Ewa Janczewska

doi:10.4254/wjh.v15.i7.914

Evaluation of the nutritional status of patients with liver cirrhosis

World J Hepatol. 2023 Jul 27;15(7):914-924. doi: 10.4254/wjh.v15.i7.914.

Authors

Barbara Janota¹, Aneta Krupowicz², Kinga Noras³, Ewa Janczewska⁴

Affiliations

¹ Department of Basic Medical Sciences, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, Bytom 41-902, Poland.
² ID Clinic, Mysłowice 41-400, Poland.
³ Department of Biometry, Warsaw University of Life Sciences, Warsaw 02-787, Poland.
⁴ Department of Basic Medical Sciences, Faculty of Public Health in Bytom, Medical University of Silesia in Katowice, Bytom 41-902, Poland. ejanczewska@sum.edu.pl.

Abstract

Background: Progressive malnutrition coexists with liver diseases, particularly in patients with cirrhosis. Early diagnosis of malnutrition in patients with advanced stages of chronic liver disease and the implementation of appropriate nutritional treatment for malnourished patients should be an integral part of the therapeutic process.

Aim: To evaluate the nutritional status of patients with various severities of advanced liver fibrosis, using various nutritional status parameters.

Methods: This study involved 118 patients with liver cirrhosis who were classified into three groups according to their Child-Pugh score. The nutritional status of the patients in each group was assessed using different methods. The average values obtained from the measurements were calculated for each research group. The influence of disease stage on the examined parameters of nutritional status was determined using one-way analysis of variance. To investigate the relationship between the parameters determining nutritional status and the stage of disease advancement, a correlation analysis was performed.

Results: The Child-Pugh A group had the highest mean body weight (76.42 kg), highest mean body mass index (BMI) (26.72 kg/m²), and largest mean arm circumference (27.64 cm). In the Child-Pugh B group, the mean scores of all examined variables were lower than those of the Child-Pugh A group, whereas the mean body weight and BMI of the Child-Pugh C group were higher than those of the Child-Pugh B group. There was a very strong correlation between the Child-Pugh classification and subjective global assessment score; a very strong correlation between the Child-Pugh classification and arm circumference; a strong correlation between the Child-Pugh classification and body weight, albumin concentration, fat-free mass index, muscle mass index, phase angle, and BMI; and an average correlation between Child-Pugh classification and fat mass index. Notably, these indicators deteriorated with disease progression.

Conclusion: Advanced liver fibrosis leads to the deterioration of many nutritional status parameters. The extent of malnutrition increases with the progression of liver fibrosis. The Child-Pugh score reflects the nutritional status.

Keywords: Fibrosis; Liver cirrhosis; Malnourishment; Nutritional status; Sarcopenia.