Prevalence and Prognostic Significance of Malnutrition in Patients with Non-Alcoholic Fatty Liver Disease (NAFLD).

Background: Non-alcoholic fatty liver disease (NAFLD) has become the primary cause of chronic liver disease. Although malnutrition is a common late-stage clinical consequence during the course of organ dysfunction and death in critical patients, it has not received sufficient attention in the context of NAFLD. The aim of this study was to explore the prevalence and prognostic significance of malnutrition in patients with NAFLD using three simple tools for nutrition assessment.

Methods: Participants (n = 3908) in the National Health and Nutrition Examination Survey (NHANES) database were divided into NAFLD (n = 1737) and non-NAFLD (n = 2171) groups. The controlling nutritional status (CONUT) score, prognostic nutrition index (PNI), and nutrition risk index (NRI) were applied to investigate the association between malnutrition and mortality among NAFLD patients.

Results: The median age of participants was 54.0 years, with females accounting for 52.2% of the study cohort. A majority of elderly male participants had NAFLD, and up to 18% of NAFLD patients suffered from malnutrition. During the average period of follow-up (24.4 ± 7.2 months), 36 all-cause deaths occurred in the NAFLD group. Multivariate analysis revealed that malnutrition was associated with significantly higher mortality compared with normal nutrition. The adjusted hazard ratio (HR) for PNI was 4.44 (95% CI: 2.07-9.53, p < 0.001), and for NRI it was 6.98 (95% CI: 1.47-33.11, p = 0.014). The CONUT score also showed a trend for association with higher mortality.

Conclusion: Malnutrition is a common comorbidity in NAFLD patients and is closely associated with poor prognosis and higher mortality. The three nutrition assessment tools employed in this study could be used to improve the predictive ability of nutritional status for mortality among NAFLD patients.