title: Malnutrition assessed through phase angle and its relation to prognosis in patients with compensated liver cirrhosis: a prospective cohort study.
abstract: BACKGROUND
  Malnutrition is a frequent complication of cirrhosis and it has been associated to more severe disease and development of complications. Phase angle is a bedside reliable tool for nutritional assessment based on conductivity properties of body tissues.
  
  
  OBJECTIVE
  To evaluate the association between malnutrition assessed through phase angle and mortality in patients with liver cirrhosis.
  
  
  METHODS
  We performed a prospective cohort study in a tertiary care centre; 249 patients were enrolled with 48 months of follow-up. Clinical, nutritional (malnutrition = phase angle ≤ 4.9°) and biochemical evaluations were performed. Student's t-test and χ(2) method were used as appropriate. Kaplan-Meier curves and multivariate Cox regression were used to evaluate mortality.
  
  
  RESULTS
  Mean follow-up was 33.5 months. Survival analysis showed higher mortality in the malnourished group compared to the well-nourished group (p = 0.076), Kaplan-Meier curves were further stratified according to compensated and decompensated status showing higher mortality in compensated patients according to Child-Pugh (p = 0.002) and Model for End-Stage Liver Disease score (p = 0.008) when malnutrition was present. Multivariate analysis showed that malnutrition was independently associated with mortality (HR = 2.15, 1.18-3.92).
  
  
  CONCLUSIONS
  In our cohort, malnutrition was independently associated with mortality. This is the first study showing higher mortality in malnourished compensated cirrhotic patients.
authors.affiliation: Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México, D.F., Mexico.
authors.forename: Astrid
authors.initials: A
authors.lastname: Ruiz-Margáin
authors.affiliation: Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México, D.F., Mexico.
authors.forename: Ricardo U
authors.initials: RU
authors.lastname: Macías-Rodríguez
authors.affiliation: Division of Gastroenterology and Hepatology, University of Arkansas for Medical Sciences, Little Rock, AR, United States.
authors.forename: Andrés
authors.initials: A
authors.lastname: Duarte-Rojo
authors.affiliation: Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México, D.F., Mexico.
authors.forename: Silvia L
authors.initials: SL
authors.lastname: Ríos-Torres
authors.affiliation: Department of Nephrology and Mineral Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México, D.F., Mexico.
authors.forename: Ángeles
authors.initials: Á
authors.lastname: Espinosa-Cuevas
authors.affiliation: Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", México, D.F., Mexico. Electronic address: detoal@yahoo.com.
authors.forename: Aldo
authors.initials: A
authors.lastname: Torre
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017097:Electric Impedance; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008099:Liver / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D044342:Malnutrition / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D055815:Young Adult
keywords: Bioelectrical impedance; Liver disease; Mortality; Nutritional status