Impaired nutritional status, frailty and inadequate dietary intake: a reality still underdiagnosed in liver cirrhosis patients

IF 4 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Digestive and Liver Disease Pub Date : 2024-09-01 DOI:10.1016/j.dld.2024.08.006

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引用次数: 0

Abstract

Introduction

Malnutrition and frailty are common in liver cirrhosis (LC) patients, increasing morbidity and mortality, especially in advanced stages. Despite their impact on prognosis, they are often overlooked and underdiagnosed.

Aim

To provide an overview of the nutritional status, frailty and dietary intake in LC patients, both outpatients and hospitalized, enrolled in a recent cross-sectional study before starting nutritional counselling.

Materials and Methods

In this prospective observational study, all consecutive LC patients attending the portal hypertension clinic and/or admitted to the gastroenterology unit at Policlinico Umberto I University Hospital from May 2023-January 2024 underwent nutritional screening. Screening included SARC-F questionnaire for sarcopenia, anthropometric measurements, liver frailty index (LFI) assessment, 24-hour diet recall, and food frequency questionnaire. Data were analyzed using Student's t-test and chi-square test by Jamovi software V2.3.28.

Results

Altogether 126 patients [72% male; age 63.7±10.7years; etiology:Alcohol-53%, MASLD-19%, Viral-20%, Others-8%; MELD- 11.8±4.4; MELD Na- 13.6±5.5; 50%Child A] were enrolled. According to SARC-F questionnaire, 36% were sarcopenic (score ≥4) and > 90% were frail or pre-frail (mean LFI 4.6±0.9). Although 65% patients consumed at least one protein source daily, 85% failed to achieve recommended daily protein intake, and 78% had lower than recommended caloric intake. Of the cohort, 68.3% were outpatient and 31.7% were hospitalized patients, with comparable age and gender distribution. Hospitalized patients had lower BMI(kg/m²) [24.7±4.1 vs 27.8±6.9;p=0.01], higher frailty scores [LFI 5.1±1.1 vs 4.3±0.7;p≤0.001], lower TSF(mm) [12.4±6.8 vs 16.2±8.1;p=0.04], and lower MUAC(cm) [29.6±5.1 vs 32.2±5.6;p=0.02] than outpatients. Further, none of the hospitalized patients met adequate protein intake, contrasting with 22% of outpatients (p=0.01).

Conclusion

There is still a high need for timely assessment of nutritional status, frailty and dietary intake in all chronic liver disease patients. This is true for both more severe hospitalized patients and outpatients and represents the premise for planning further lifestyle interventions to optimize patient outcomes.

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肝硬化患者营养状况受损、身体虚弱和饮食摄入不足：仍未得到充分诊断的现实情况

导言营养不良和体弱是肝硬化（LC）患者的常见病，会增加发病率和死亡率，尤其是在晚期。材料与方法在这项前瞻性观察研究中，2023 年 5 月至 2024 年 1 月期间，所有在翁贝托一世大学医院门静脉高压症门诊就诊和/或在消化科住院的连续肝硬化患者均接受了营养筛查。筛查内容包括 SARC-F 肌肉疏松症问卷、人体测量、肝脏虚弱指数（LFI）评估、24 小时饮食回忆和食物频率问卷。结果共纳入 126 名患者[72% 男性；年龄（63.7±10.7）岁；病因：酒精-53%，MASLD-19%，病毒-20%，其他-8%；MELD- 11.8±4.4；MELD Na- 13.6±5.5；50% 儿童 A]。根据 SARC-F 问卷调查，36% 的患者为肌无力（评分≥4），> 90% 的患者为虚弱或前期虚弱（平均 LFI 为 4.6±0.9）。虽然 65% 的患者每天至少摄入一种蛋白质来源，但 85% 的患者未能达到推荐的每日蛋白质摄入量，78% 的患者热量摄入量低于推荐值。队列中，68.3%为门诊患者，31.7%为住院患者，年龄和性别分布相当。与门诊患者相比，住院患者的体重指数（kg/m2）较低[24.7±4.1 vs 27.8±6.9；p=0.01]，虚弱评分较高[LFI 5.1±1.1 vs 4.3±0.7；p≤0.001]，TSF（mm）较低[12.4±6.8 vs 16.2±8.1；p=0.04]，MUAC（cm）较低[29.6±5.1 vs 32.2±5.6；p=0.02]。结论所有慢性肝病患者的营养状况、虚弱程度和饮食摄入量仍亟待及时评估。无论是病情较重的住院患者还是门诊患者，都需要对营养状况、虚弱程度和饮食摄入量进行及时评估，这也是规划进一步生活方式干预措施以优化患者预后的前提。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Digestive and Liver Disease 医学-胃肠肝病学

CiteScore

6.10

自引率

2.20%

发文量

632

审稿时长

19 days

期刊介绍： Digestive and Liver Disease is an international journal of Gastroenterology and Hepatology. It is the official journal of Italian Association for the Study of the Liver (AISF); Italian Association for the Study of the Pancreas (AISP); Italian Association for Digestive Endoscopy (SIED); Italian Association for Hospital Gastroenterologists and Digestive Endoscopists (AIGO); Italian Society of Gastroenterology (SIGE); Italian Society of Pediatric Gastroenterology and Hepatology (SIGENP) and Italian Group for the Study of Inflammatory Bowel Disease (IG-IBD). Digestive and Liver Disease publishes papers on basic and clinical research in the field of gastroenterology and hepatology. Contributions consist of: Original Papers Correspondence to the Editor Editorials, Reviews and Special Articles Progress Reports Image of the Month Congress Proceedings Symposia and Mini-symposia.