Evaluation of nutritional status of nonhospitalized patients with liver cirrhosis

Abstract

-Background -Protein-calorie malnutrition is a frequent fi nding in patients with chronic liver disease, but investigations of nutritional status have been rarely performed in individuals seen at outpatient clinics. Aim -To evaluate the nutritional status of patients with alcoholic and nonalcoholic cirrhosis, attended for the fi rst time at a reference outpatient clinic for liver diseases. Patients and methods -A total of 300 consecutive patients attended at the outpatient clinics of a reference center for liver diseases were investigated. Anthropometric evaluation was performed by the usual parameters: triceps skinfold, arm circumference and arm muscle circumference. Biochemical parameters included creatinine/height index, serum albumin and lymphocytes count. The nutritional diagnosis was based on the PCM score proposed by Mendenhall et al. Food intake was retrospectively evaluated using 24-hour dietary recall data. Results -About 71% of the patients studied were chronic alcohol abusers, whereas in 29% cirrhosis was of nonalcoholic etiology. Independently of the disease etiology 75.3% of the patients showed some degree of protein-calorie malnutrition, which was moderate or severe in 38.3% of them. More advanced protein-calorie malnutrition degrees were associated with lower energy and protein intake. The prevalence of moderate or severe protein-calorie malnutrition was higher in patients classifi ed as Child-Pugh C than in patients classifi ed as Child-Pugh A (21% x 58%, respectively). Regarding sexual differences, fat reserves, evaluated by triceps skinfold, were more depleted in females than in males (48.6% x 26.6%) regardless of the etiology of the cirrhosis, whereas muscle reserves (arm muscle circumference) were more depleted in males (43.4% x 13.4%) regardless of the etiology of cirrhosis. In contrast, cirrhosis of alcoholic etiology was determinant in reducing arm muscle circumference in females (20% x 9.1%).Conclusions -These data highlight the high prevalence of protein-calorie malnutrition occurring early in the natural history of the disease and accompanying functional hepatic deterioration. In addition, attention should be paid to the different gender patterns of response to protein-calorie malnutrition in these patients. HEADINGS -Nutritional status. Liver cirrhosis. Outpatients.

Nutritional profile of asymptomatic alcoholic patients

“…Most clinical studies about malnutrition in alcoholics do not separate subjects with visceral disease from those without, or consequences of simply reduced energy intake from more specific alcohol effects (8) . Few classic studies have been updated, references in modern surveys about protein-calorie and vitamin deficits often being 10-20 years old (15,21) .…”

Avaliação nutricional do paciente cirrótico: Uma nova abordagem através da bioimpedância elétrica

“…Malnutrition also has important implications in liver transplantation and it has been demonstrated that patients with a worse nutritional status before the transplant have increased postoperative complications and higher mortality rates. 5 In a study on 300 patients, Carvalho et al 6 showed that more than 55% of those with advanced hepatic disease had some degree of malnutrition, which was moderate to severe in 40%. In the same study, 95% of Child-Pugh class C patients were malnourished, as also were 74% of class B and 46% of class A patients.…”

“…In the same study, 95% of Child-Pugh class C patients were malnourished, as also were 74% of class B and 46% of class A patients. 6 The high prevalence of malnutrition even in patients in the early stages of the disease is a source of concern. Among the causes of malnutrition in these patients, particularly important are insufficient food intake, malabsorption and metabolic disorders.…”

Avaliação dos indicadores nutricionais e da composição corporal em hepatopatas crônicos e a relação com a etiologia e gravidade da doença

“…(106) Apesar do crescimento atual da CH por VHC, a doença hepática de etiologia alcoólica ainda encontra-se bastante presente na prática clínica e em algumas instâncias estando superior a decorrente do VHC. Em concordância com outros estudos (20,107,108) , a prevalência da etiologia alcoólica neste estudo foi elevada. O predomínio da etiologia por álcool pode estar relacionado ao predomínio do sexo masculino na amostra estudada.…”

“…Esta depleção no tecido muscular pode estar relacionada ao efeito direto do álcool sobre o metabolismo do músculo esquelético. (32,93) Carvalho & Parise (2006) (107) (114) . A relação da etiologia com a gravidade pode estar associada à maior prevalência de ascite, encefalopatia hepática e HDA neste grupo de pacientes.…”