Evaluation of nutritional practice in hospitalized cirrhotic patients: results of a prospective study.
OBJECTIVE
We evaluated the impact of malnutrition and nutrition practice in 396 hospitalized cirrhotic patients (Child stages A, B, and C: 60, 169, and 167 patients) in a readaptative unit for liver diseases.


METHODS
Triceps skinfold thickness and mid-arm muscle circumference were measured at admission, and spontaneous dietary intake was evaluated at admission and during hospital stay.


RESULTS
Ascites was associated with impairment of nutrition status: 49% and 30.4% of non-ascitic patients, 49.1% and 40.5% of patients with mild ascites, and 65.5% and 48.3% of patients with tense ascites had mid-arm muscle circumferences and triceps skinfold thicknesses, respectively, below the fifth percentile of a reference population (P < 0.05 and P = 0.02, respectively). Decrease in dietary intake paralleled worsening of liver failure: 48% and 34% of Child A patients, 51.7% and 35.8% of Child B patients, and 80.3% and 62.9% of Child C patients at admission had caloric intakes below 30 kcal/kg of body weight and protein intakes below 1 g/kg of body weight, respectively (P < 0.001). Mortality rate was 15.4% during hospital stay; Child-Pugh score (P = 0.0014), age (P = 0.0029), severe septic complications (P = 0.0050), and decrease in caloric intake during hospital stay (P = 0.0072) were independently associated with mortality. Twenty-four patients received enteral feeding that was initiated before admission in four patients and after 12.4 +/- 8.3 d of hospitalization in 20 patients because of low caloric intake (<25 kcal/kg) despite oral supplements. Patients receiving enteral feeding were older (P < 0.01), had a higher Child-Pugh score (P < 0.01), and a higher mortality rate (P < 0.001) than other patients.


CONCLUSIONS
Hospitalized cirrhotic patients have a high prevalence rate of malnutrition, and most do not satisfy their nutritional requirements. Decrease in caloric intake is an independent risk factor of short-term mortality. Enteral nutrition after failure of oral supplementation has no clinical benefit. Tube feeding may be indicated earlier in the course of the disease.
Campillo
Bernard
B
Service de Rééducation Digestive, Hôpital Albert Chenevier, Assistance Publique-Hôpitaux de Paris, 40 rue de Mesly, 94010 Créteil, France. bernard.campillo@ach.ap-hop-paris.fr
Richardet
Jean-Philippe
JP
Scherman
Elizabeth
E
Bories
Phuong Nhi
PN
D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001201:Ascites / Q000453:epidemiology; D004032:Diet; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D004750:Enteral Nutrition; D005260:Female; D006760:Hospitalization; D006801:Humans; D007239:Infections / Q000150:complications; D008103:Liver Cirrhosis / Q000145:classification / Q000401:mortality / Q000628:therapy*; D008104:Liver Cirrhosis, Alcoholic / Q000145:classification / Q000401:mortality / Q000628:therapy; D017093:Liver Failure / Q000150:complications / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000150:complications / Q000453:epidemiology; D009752:Nutritional Status; D018529:Nutritional Support / Q000706:statistics & numerical data; D011446:Prospective Studies
D004044:Dietary Proteins