Nutrition in Chronic Liver Disease: A Point‐of‐Care Review

Ghufran, Aiman

doi:10.1002/ncp.10470

Cited by 13 publications

(12 citation statements)

References 65 publications

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“…[6][7][8] Due to the critical impact of race on skeletal muscle mass and strength, the European Working Group on Sarcopenia in Older People and the International Working Group on Sarcopenia suggested that the diagnosis of sarcopenia should be based on local population norms. 8,9 Because the aetiology of cirrhosis and characteristics of cirrhotic patients are markedly different in China than in Western populations, it is inappropriate to apply the criteria established in Western populations to Chinese subjects. Some recent studies documented that a low L3-SMI value might be a relatively strong predictor of a poor prognosis and was associated with a high risk of cirrhosis-related complications, such as hepatic encephalopathy (HE), ascites, spontaneous bacterial peritonitis (SBP), and hepatorenal syndrome (HRS).…”

Section: Introductionmentioning

confidence: 99%

Sarcopenia as a prognostic predictor of liver cirrhosis: a multicentre study in China

Zeng

Shi

et al. 2021

J cachexia sarcopenia muscle

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Background Diagnostic criteria for sarcopenia have not been established in Chinese. This study established criteria based on the L3-skeletal muscle index (L3-SMI) and assessed its value for outcomes predicting in cirrhotic Chinese patients. Methods Totally 911 subjects who underwent a CT scan at two centres were enrolled in Cohort 1 (394 male and 417 female subjects, aged 20-80 years). The data of those subjects younger than 60 years (365 male and 296 female subjects) were used to determine the reference intervals of the L3-SMI and its influencing factors. Cohort 2 consisted of 480 patients (286 male and 184 female patients) from three centres, and their data were used to investigate the prevalence of sarcopenia and evaluate the value of L3-SMI for predicting the prognosis and complications of cirrhosis. Results Age and sex had the greatest effects on the L3-SMI (P < 0.001). The L3-SMI scores were clearly higher in male patients than in female patients (52.94 ± 8.41 vs. 38.91 ± 5.65 cm 2 /m 2 , P < 0.001) and sharply declined in subjects aged ≥ 60 years. Based on the mean À1.28 × SD among adults aged < 60 years, the L3-SMI cut-off value for sarcopenia was 44.77 cm 2 /m 2 in male patients and 32.50 cm 2 /m 2 in female patients. Using these values, 22.5% of the cirrhotic patients (28.7% of male patients and 11.9% of female patients) were diagnosed with sarcopenia. Compared with non-sarcopenia individuals, sarcopenia patients had lower body mass index (21.28 ± 3.01 vs. 24.09 ± 3.39 kg/m 2 ,

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Section: Introductionmentioning

confidence: 99%

Sarcopenia as a prognostic predictor of liver cirrhosis: a multicentre study in China

Zeng

Shi

et al. 2021

J cachexia sarcopenia muscle

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“…5 Malnutrition in patients with liver disease has been reported to varying degree from 10% to 100% in different studies conducted at different institutes. 14,15 It is a very good prognostic factor 16,17 and an independent predictor of mortality. 18 In present study rate of malnutrition was significantly high in class B and C (p=0.002).…”

Section: Resultsmentioning

confidence: 99%

Assessment of Malnutrition in Chronic Liver Disease Patients with the Child Pugh Classification at a Large Tertiary Care Center in Karachi, Pakistan

Qazi

Basar

Qazi

et al. 2021

APMC

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Background: Child Pugh classification is an easy-to-use method that allows Physicians to assess malnutrition in patients suffering from CLD. Objective: To determine the frequency of malnutrition at different stages of chronic liver disease in accordance with Child Pugh classification. Study Design: The type of study is a cross-sectional study. Settings: Medical Unit III Civil Hospital, Karachi Pakistan. Duration: Six months from 31st May 2016 to 30th November 2016. Methodology: All the patients between the age 30 to 60 years who are known cases of CLD secondary to hepatitis B, C or both, with active signs of CLD were included. All the patients having debilitating co-morbidities likes malignancy, TB, psychiatric, etc. were excluded. Anthropometric evaluation and lab investigation at the time of admission were performed for all the patients. Results: The average age was 48.12±8.521 years and duration of disease was 5.48±3.792 months. There were 61.54% male and 38.46% females. Hepatitis-B was observed in 19.91% (n=44) cases, Hepatitis-C was 62.44% (n=62.44) and both hepatitis B and C was observed in 17.65% (n=39) cases. According to Child Pugh score, 9.5% cases were in class A, 32.58% were in class B and 57.92% were in class C. Frequency of malnutrition in chronic liver disease patients was 62.44% (138/221). Rate of malnutrition was significantly high in class B and C (p=0.002). Rate of malnutrition was also observed to be significantly high in those cases who were positive for both hepatitis like B and C (p=0.001). Effect of duration of cirrhosis was also not statistically significant with malnutrition. Conclusion: Malnutrition was significantly common among chronic liver disease patients regardless of viral etiology. Child Pugh B & C patients were found to have more significant malnourished states.

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“…Vitamin K deficiency results from declining hepatic reserves, increasing the risk of bleeding; while vitamin D deficiency can be caused from a reduced ingestion and absorption. Absorption is impaired in underexposure to ultraviolet light as well as in cholestatic disease or portal hypertension enteropathy[ 54 ]. Patients with abnormal liver functioning have deficient vitamin D levels as hydroxylation is required to synthesis calcidiol.…”

Section: Etiology and Pathophysiologymentioning

confidence: 99%

“…The subsequent magnesium deficiency can cause dysgeusia and contribute to minimal HE, which further decreases the patients’ intakes and worsens outcomes. Clinical improvement is therefore noted with magnesium supplementation[ 54 ]. Table 1 summarizes the effects of each micronutrient deficiency caused by liver disease.…”

Section: Etiology and Pathophysiologymentioning

confidence: 99%

Malnutrition and liver disease in a developing country

Siddiqui¹,

Parkash²,

Hashmi³

2021

WJG

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Malnutrition is a highly prevalent and under recognized condition in developing countries of South Asia. The presence of malnutrition causes a severe impact on patients with liver cirrhosis. The etiology of cirrhosis differs in the South Asian region compared to the West, with hepatitis B and C still being the leading causes and the prevalence of nonalcoholic fatty liver disease increasing over time. Comorbid malnutrition worsens outcomes for cirrhosis patients. Urgent attention to address malnutrition is needed to improve patient outcomes. The etiology and pathophysiology of malnutrition in liver diseases is multifactorial, as reduction in liver function affects both macronutrients and micronutrients. A need for nutritional status assessment for liver disease patients exists in all parts of the world. There are many widely studied tools in use to perform a thorough nutritional assessment, of which some tools are low cost and do not require extensive training. These tools can be studied and evaluated for use in the resource limited setting of a country like Pakistan. Treatment guidelines for proper nutrition maintenance in chronic liver disease exist for all parts of the world, but the knowledge and practice of nutritional counseling in Pakistan is poor, both amongst patients and physicians. Emphasis on assessment for nutritional status at the initial visit with recording of vital signs is needed. Simultaneously, treating physicians need to be made aware of the misconceptions surrounding nutritional restrictions in cirrhosis so that patient education is done correctly based on proper scientific evidence.

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Nutrition in Chronic Liver Disease: A Point‐of‐Care Review

Cited by 13 publications

References 65 publications

Sarcopenia as a prognostic predictor of liver cirrhosis: a multicentre study in China

Sarcopenia as a prognostic predictor of liver cirrhosis: a multicentre study in China

Assessment of Malnutrition in Chronic Liver Disease Patients with the Child Pugh Classification at a Large Tertiary Care Center in Karachi, Pakistan

Malnutrition and liver disease in a developing country

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