title: Insufficient Protein Intake Is Associated With Increased Mortality in 630 Patients With Cirrhosis Awaiting Liver Transplantation.
abstract: BACKGROUND
  For patients awaiting liver transplantation, we aimed to determine the prevalence and predictors of insufficient protein intake as well as to determine whether very low protein intake was an independent predictor of malnutrition and mortality.
  
  
  METHODS
  Adults with cirrhosis who were activated on our local liver transplant waiting list between January 2000 and October 2009 were included. Estimated protein intake was derived from dietary records. Patients with incomplete dietary records were excluded. Multivariable logistic regression and competing risk analysis were used.
  
  
  RESULTS
  Of 742 potential patients, 112 were excluded due to insufficient data, leaving 630 patients for evaluation. Mean protein intake was 1.0 ± 0.36 g/kg/d and only 24% of patients met the expert consensus recommended threshold of > 1.2 g/kg of protein per day. Very low protein intake (< 0.8 g/kg/d) was associated with worse liver disease severity (as measured by Child-Pugh or MELD). Protein intake below 0.8 g/kg/d was an independent predictor both of malnutrition as measured by the subjective global assessment (adjusted odds ratio [95% confidence interval (CI)]: 2.0 [1.3-3.0]) and of transplant waiting list mortality (adjusted hazard ratio [95% CI]: 1.8 [1.2-2.7]).
  
  
  CONCLUSIONS
  In this large cohort of liver transplant waitlisted patients, very low protein intake was prevalent and independently associated with malnutrition and mortality. Unlike many other prognostic factors, protein intake is potentially modifiable. Prospective studies are warranted to evaluate the effect of targeted protein repletion on clinically relevant outcomes such as muscle mass, muscle function, immune function, and mortality.
authors: Cirrhosis Care Clinic, Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
authors: Michael
authors: M
authors: Ney
authors: Cirrhosis Care Clinic, Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada Liver Transplant Unit, University of Alberta, Edmonton, Alberta, Canada.
authors: Juan G
authors: JG
authors: Abraldes
authors: Cirrhosis Care Clinic, Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada Liver Transplant Unit, University of Alberta, Edmonton, Alberta, Canada.
authors: Mang
authors: M
authors: Ma
authors: Liver Transplant Unit, University of Alberta, Edmonton, Alberta, Canada.
authors: Dawn
authors: D
authors: Belland
authors: Liver Transplant Unit, University of Alberta, Edmonton, Alberta, Canada.
authors: Andrea
authors: A
authors: Harvey
authors: Division of Gastroenterology, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
authors: Sarah
authors: S
authors: Robbins
authors: Cirrhosis Care Clinic, Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada Liver Transplant Unit, University of Alberta, Edmonton, Alberta, Canada.
authors: Vanessa
authors: V
authors: Den Heyer
authors: Cirrhosis Care Clinic, Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada Liver Transplant Unit, University of Alberta, Edmonton, Alberta, Canada ptandon@ualberta.ca.
authors: Puneeta
authors: P
authors: Tandon
mesh_terms: D000328:Adult; D004044:Dietary Proteins / Q000008:administration & dosage*; D004435:Eating; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality* / Q000601:surgery; D016031:Liver Transplantation; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000401:mortality*; D008875:Middle Aged; D015596:Nutrition Assessment; D011379:Prognosis; D011488:Protein Deficiency / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014850:Waiting Lists / Q000401:mortality*
chemical_list: D004044:Dietary Proteins
keywords: dietary intake; liver cirrhosis; liver transplantation; malnutrition; mortality; nutrition assessment