Evaluating the Impact of Early Nutritional Assessment and Intervention in Hospitalized Liver Cirrhosis Patients

Abstract

Background Malnutrition is common in liver cirrhosis patients that is correlated with early complications, morbidity and mortality. Objective The purpose of the study was to assess nutritional status, impact of nutritional screening and intervention in liver cirrhosis patients by evaluating their actual energy and protein intake during hospital stay. Methods A cross sectional study was conducted wherein all patients’ nutritional status was defined by Subjective Global Assessment tool. Adequate energy and protein supply were planned and executed by using individualized nutritional plan for patients with dietitian’s collaboration. Anthropometric measurements included height, weight, body mass index, mid upper arm circumference, hand grip strength and triceps skin-fold thickness. Biochemical tests included haemoglobin, mean corpuscular haemoglobin, volume and concentration, albumin and liver function tests. To record the daily food intake, a 24-hour dietary recall was used. Results Overall 83 patients (mean age 55) were included, among them 46% of patients were moderately malnourished, 12% were normal, while 42% of cirrhotic patients were severely depleted according to Subjective Global Assessment. The mean intake of calories and protein was improved during stay in hospital after nutritional intervention and critical monitoring (P<0.05). Anthropometric measurements at baseline and discharge showed significant differences (P <0.05) in weight, body mass index, triceps skin fold thickness and mid upper arm circumference values, but not in hand grip strength that was associated with malnourishment among patients. Conclusion Providing individualized nutritional intervention and its monitoring by qualified dietitians during hospital stay helps to improve intake in patients that prevent further risk of malnutrition and related complications.

Nutritional screening and assessment tools for patients with cirrhosis based on the Global Leadership Initiative on Malnutrition criteria

“…2 Malnutrition has become an important cause of mortality in patients with cirrhosis, and the incidence increases with the disease severity. 26,27 The present study identified associations between the nutritional status of patients with cirrhosis and disease progression using validated screening assessment tools.…”

“…Liver dysfunction leads to malnutrition, which may develop insidiously in the early stages of chronic liver disease, eventually leading to protein‐energy malnutrition 2 . Malnutrition has become an important cause of mortality in patients with cirrhosis, and the incidence increases with the disease severity 26,27 . The present study identified associations between the nutritional status of patients with cirrhosis and disease progression using validated screening assessment tools.…”