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. 2020 Oct 27;12(10):829-840.
doi: 10.4254/wjh.v12.i10.829.

Malnutrition and non-compliance to nutritional recommendations in patients with cirrhosis are associated with a lower survival

Dana Crisan  1 , Bogdan Procopet  2 , Alexandra Epure  2 , Horia Stefanescu  3 , Alina Suciu  2 , Andreea Fodor  2 , Emil Mois  4 , Rares Craciun  5 , Nicolae Crisan  1
Affiliations

Malnutrition and non-compliance to nutritional recommendations in patients with cirrhosis are associated with a lower survival

Dana Crisan et al. World J Hepatol. .

Abstract

Background: Malnutrition is frequently encountered in patients with cirrhosis and appears to significantly impact their prognosis. While evaluating the burden of malnutrition in cirrhosis is gathering momentum, as suggested by multiple recently published reports, there is still a persistent scarcity of solid data in the field, especially with regards to the role of nutritional interventions.

Aim: To assess the prevalence of malnutrition in patients with advanced cirrhosis and to evaluate its impact on survival.

Methods: One hundred and one consecutive patients with advanced cirrhosis were screened for malnutrition using the Subjective Global Assessment (SGA) criteria and the mid-arm circumference (MAC). Malnutrition was defined as SGA class B and C and MAC < 10th percentile. All patients were interviewed regarding their food intake using an adapted questionnaire. Subsequently, total energy intake was calculated and further subdivided in main nutrients. The data were then compared to the available recommendations at the time of analysis to assess adherence.

Results: 54/79 patients (68.4%) in the decompensated group had malnutrition, while only 3/22 patients (13.6%) were malnourished in the compensated group. After a median follow-up time of 27 mo (0-53), the overall mortality was 70%. Survival was significantly lower among patients with malnutrition. The mortality rates were 50% at 1 year and 63% at 2 years for the patients with malnutrition, compared to 21% at 1 year and 30% at 2 years for patients without malnutrition (P = 0.01). On multivariate analysis, the factors independently associated with mortality were age, creatinine level and adherence to the protein intake recommendations. The mortality was lower in patients with the appropriate protein intake: 8% at 1 year and 28% at 2 years in the adherent group, compared to 47% at 1 year and 56% at 2 years in the non-adherent group.

Conclusion: The prevalence of malnutrition is high among patients with advanced cirrhosis and might be related in part to a low adherence to nutritional recommendations, especially with regards to protein intake.

Keywords: Decompensated cirrhosis; Malnutrition; Protein intake; Subjective global assessment; Survival.

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Conflict of interest statement

Conflict-of-interest statement: There are no conflicts of interest to report.

Figures

Figure 1
Figure 1
Patient enrollment algorithm.
Figure 2
Figure 2
Kaplan-Meier curves of survival according to the presence of malnutrition based on Subjective Global Assessment criteria (malnourished–blue line; well nourished-green line). SAG: Subjective Global Assessment.
Figure 3
Figure 3
Kaplan-Meier curves of survival according to the adherence of protein intake recommendation of 1.2-1.5 g/kg/d (patients adhered to protein intake recommendation - green line vs non-adherent – blue line).
See this image and copyright information in PMC

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