Food Consumption of Cirrhotic Patients, Comparison With the Nutritional Status and Disease Staging

Abstract

-Background -Patients with liver disease often present protein-energy malnutrition. The assessment of food intake is very important in the investigation regarding the "health-disease" process. Objective -To assess dietary intake of cirrhotic patients through food record during 3 days, correlating it with the nutritional status of the patient and the stage of the disease. Methods -Cirrhotic outpatients from the Santa Casa de Misericórdia Hospital, RS, Brazil, were assessed. Nutritional assessment was performed by anthropometry; non-dominating handgrip strength; adductor pollicis muscle thickness; phase angle by bioelectrical impedance analysis; and Subjective Global Assessment. For analysis of food consumption we used the food records of 3 days using scales for weighing of all foods. Results -We evaluated 25 (68%) patients, in which there was a prevalence of cirrhosis by hepatitis C virus. The upper arm circumference, handgrip strength and phase angle by bioelectrical impedance analysis diagnosed 56% of malnourished. Phase angle by bioelectrical impedance analysis and upper arm circumference were associated with Child-Pugh score (P<0.05). The average consumption of calories, carbohydrates, proteins and lipids were within the recommended. However, sodium was above the recommendations, 106±57.2 mEq, and was inversely associated with Child-Pugh score (rs=-0.410; P=0.042). Conclusion -Food intake did not have a significant difference between the Child-Pugh scores and nutritional status. In addition, food intake did not vary neither according to the stage of the disease, nor to the nutritional assessment, by the phase angle by bioelectrical impedance analysis.

A Comprehensive Review of Bioelectrical Impedance Analysis and Other Methods in the Assessment of Nutritional Status in Patients with Liver Cirrhosis

“…This procedure should increase the effectiveness of BIA assessment. It has also been proven that phase angle (PA) can serve as a powerful indicator of survival and even correlate with the Child-Pugh score [15]. The accurate assessment of nutritional status among cirrhotic patients might lead to the improvement in their management and appropriate treatment [16, 17].…”

“…Thus, handgrip strength (HS) might be a solution for patients with low-grade HE to evaluate nutritional status. During this procedure, the strength exerted by a nondominant hand is measured with a dynamometer [15]. It has been reported as a simple and valuable tool by several guidelines in accomplishing cirrhosis decompensation.…”

“…The psoas muscle index has also been proved to correlate with clinical parameters and the degree of skeletal muscle mass loss in cirrhotic patients. Nevertheless, the skeletal muscle index at the third lumbar vertebra is described as the most reliable single imaging which correlates to the whole body muscle mass [15, 42, 98–102]. …”

Optimizing the Nutritional Support of Adult Patients in the Setting of Cirrhosis

“…For example, weight and albumin concentrations could be unreliable measurements alone due to other complications from cirrhosis, such as ascites or low protein synthesis, respectively [ 10 , 18 , 19 ]. Other cross-sectional studies looking at nutritional assessment techniques found that the use of a variety of techniques, such as the SGA, biochemical tests, and anthropometry, lead to a better understanding of nutritional status [ 2 , 20 , 21 , 22 ]. A variety of tests should be used to evaluate different aspects and severity of nutrition rather than any single nutritional screening tool, thus creating a multidisciplinary approach shown in Figure 2 [ 1 , 19 ].…”

Muscle depletion in cirrhotic patients assessed using computed tomography: a cross-sectional study

“…The prevalence of protein-energy malnutrition is around 20%-30% among patients with chronic liver disease and over 60% among patients with advanced cirrhosis. [7][8][9][10][11] Sarcopenia has been described as a syndrome characterized by progressive and extensive loss of strength and skeletal muscle mass, with a risk of unfavorable outcomes, including patient morbidity and mortality. 7,[11][12][13][14] It is one of the most common complications in cirrhotic patients, with prevalence ranging from 30% to 70%, and it involves reduced quality of life and increased infection rates.…”