Nutritional Assessment and Clinical Determinants in Patients Awaiting Liver Transplant

Abstract

Background: Malnutrition is a usual problem in liver cirrhosis patients, progressing with advancement of disease. Protein-calorie malnutrition is related with illness and death, and the value of nutritional status assessment tools for malnutrition is debated. We conducted this study to monitor undernutrition assessment among cirrhotics using subjective global assessment (SGA) and standard anthropometric parameters and to observe the association of different clinical characteristics with SGA score and Child-Pugh classification. Methods: Patients enrolled wereend-stage liver disease (ESLD) patientsand obtained informed consent. The nutritional screening was performed using the SGAand standard anthropometry along with mid-upper arm circumference (MUAC), mid-arm muscle circumference (MAMC), triceps skin fold thickness (TST), and hand grip strength (HGS). Results: 141 ESLD patients awaiting liver transplant (LT) were enrolled in the study and among them, 113 (80.1%) were males and 28 (19.9%) females. Patient’s average age at presentation was 49.5 years. Alcoholism was the major etiological factor (51.1%) and its median duration was 10 years. The liver disease severity as per Child-Pugh classification was as follows: the majority, 66 (46.8%), were in Child-Pugh category B, and 27 (19.1%) were in Child-Pugh category C. The comparison of nutritional parameters with the Child-Pugh classification showed a statistical significance (P<0.05) with BMI (body mass index) and MAMC between the Child-Pugh categories. The comparison of SGA nutrition scores shows that it does not significantly differ on average between gender, Child-Pugh classification, aetiologies, co-morbidity, oedema, and ascites status. The nutritional score was further categorized as normal, moderately malnourished, and severely malnourished based on the SGA score, and it shows that the nutritional level is significantly correlated with Child-Pugh classification and co-morbidity. The level of liver function parameters was not correlated with the level of different nutritional parameters. Conclusion: SGA and HGS can be used as an easy and economical tool for evaluating the level of nutrition among cirrhotics and can be consistently used in liver clinics for malnutrition screening, and one can plan for nutrition education and counselling. Nutritional level monitoring is challenging in patients with ESLD due to fluid retention, and SGA will be a better nutritional screening tool for nutritional assessment.