title: Malnutrition is a prognostic factor in patients with hepatocellular carcinoma (HCC).
abstract: OBJECTIVE
  Malnutrition is a common, hence frequently underdiagnosed condition in patients with liver cirrhosis as well as in patients with cancer and has been shown to have a negative impact on survival in these patients. Frequently applied screening tools including anthropometric measurements or laboratory parameters to screen for malnutrition are not suitable for patients with liver cirrhosis with additional pathophysiological mechanisms leading to hypoalbuminemia and edema. Prospective data on the prevalence and prognostic impact of malnutrition in patients with HCC are scarce.
  
  
  METHODS
  Fifty-one consecutive patients with hepatocellular carcinoma were prospectively enrolled into this study and screened for malnutrition by anthropometric measurements, the MNA score, the NRS score, laboratory work-up, and BIA measurement. The results of the different screening tools were compared to each other and with the BIA assessment and correlated with the outcome of patients.
  
  
  RESULTS
  The calculation of a body mass index (BMI) was not suitable to identify malnourished patients with HCC. The MNA identified 19, the NRS score 17 patients at a risk for malnutrition. BIA revealed a reduction in relative body cell mass in 12 patients. Univariate Cox regression analyses identified tumor stage, MNA score, and phase angle obtained by BIA as significant factors with influence on survival. Multivariate analyses confirmed the phase angle at a cut-off of 4.8 to be an independent factor.
  
  
  CONCLUSIONS
  A significant proportion of patients with HCC is malnourished or at risk for malnutrition. Screening questionnaires and BIA measurement are superior to pure anthropometric measurements to identify the condition that negatively influences survival. The phase angle derived from body impedance analysis is an independent prognostic factor in patients with HCC.
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Magdeburg, Germany.
authors.forename: Kerstin
authors.initials: K
authors.lastname: Schütte
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Magdeburg, Germany.
authors.forename: Bernadett
authors.initials: B
authors.lastname: Tippelt
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Magdeburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Schulz
authors.affiliation: Institute for Biometry and Medical Informatics, Otto-von-Guericke University, Magdeburg, Germany.
authors.forename: Friedrich-Wilhelm
authors.initials: FW
authors.lastname: Röhl
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Magdeburg, Germany.
authors.forename: Anja
authors.initials: A
authors.lastname: Feneberg
authors.affiliation: Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany.
authors.forename: Ricarda
authors.initials: R
authors.lastname: Seidensticker
authors.affiliation: Department of General, Visceral and Vascular Surgery, Otto-von-Guericke University, Magdeburg, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Arend
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Magdeburg, Germany. Electronic address: peter.malfertheiner@med.ovgu.de.
authors.forename: Peter
authors.initials: P
authors.lastname: Malfertheiner
mesh_terms: D000368:Aged; D001823:Body Composition; D015992:Body Mass Index; D006528:Carcinoma, Hepatocellular / Q000150:complications*; D017097:Electric Impedance; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications*; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000175:diagnosis*; D015596:Nutrition Assessment; D009752:Nutritional Status; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
keywords: BIA; Hepatocellular carcinoma; Malnutrition; Phase angle; Prognosis