Assessment of Nutritional Status in Cirrhosis and Comparison of Severity Between Alcoholic and Non-alcoholic Aetiology – a Prospective Observational Study

Abstract

Introduction: Malnutrition and muscle wasting in cirrhosis negatively impact survival, quality of life. Conventionally these are not entirely looked for in cirrhosis patients, as nutritional assessment can be difficult, especially if there is associated fluid retention. The cause of the morbidity and mortality in cirrhosis is multifactorial and one important contributor is malnutrition. Nutritional deficiencies are also common among these patients mainly from decreased dietary intake, but also as a result of altered metabolism, decreased nutrient storage and increased nutrient requirements. Methods to detect malnutrition early in the course of the disease may be useful in providing medical nutritional therapy and reducing the morbidity and mortality in cirrhosis.
Objective: To assess nutritional status and compare assessment methods in patients of alcoholic & non-alcoholic cirrhosis by Anthropometry, Handgrip strength (HGS), Creatinine Height Index (CHI) and Psoas Muscle, Thickness per Height (PMTH).
Methods: It was a prospective observational study of 57 consecutive admitted patients of Cirrhosis, for nutritional status assessment in a tertiary care set up in eastern Indian state, Odisha during the period from September 2018 to August 2020.
Results: Study population: 57; majority are of male and alcohol aetiology. Prevalence of malnutrition was 63.84% according to SGA score. There was significant decrease in values of HGS, CHI, PMTH with increasing malnutrition severity. CHI had highest sensitivity (94.44%) and lesser specificity (90.47%) with cut off value of 61.69%, followed by non-dominant HGS (sensitivity:87.87%; specificity: 92.85%). Malnutrition severity was not congruent with values of Dry weight BMI, Anthropometry data.
Conclusion: Handgrip strength of a nondominant hand by dynamometer appeared to be a better practical bedside objective tool in screening, diagnosis and categorizing malnutrition compared to other significant methods like CHI, PMTH and biochemical parameters. This study also highlights fallacy of usefulness of commonly applied nutrition screening methods like anthropometry and Body Mass Index (BMI) in cirrhosis patients. And suggests an integrated approach with multiple subjective and objective tools for assessing nutrition status in cirrhosis.