title: Malnutrition in cirrhosis increases morbidity and mortality.
abstract: OBJECTIVE
  Malnutrition is frequent in patients with cirrhosis and is associated with complications like ascites, hepatic encephalopathy, infections, and death. We determined the prevalence of malnutrition by various methods and its clinical importance in patients with cirrhosis.
  
  
  METHODS
  Consecutive patients of cirrhosis from August 2013 to February 2015 were assessed. Nutritional status was assessed by traditional model (mid-arm circumference, triceps skinfold thickness, serum albumin, creatinine height index, total lymphocyte count), handgrip, and body composition analysis measuring skeletal muscle mass and body fat mass. All patients were followed up for 12 months to assess the outcome.
  
  
  RESULTS
  247 patients (age 42.10 ± 10.14 years, 81% male) were included in the study. Etiology of cirrhosis was alcohol in 53% patients. Prevalence of malnutrition was 59.5% according to traditional model, 66.8% by body composition analysis and 71.4% by handgrip. Nutritional status was poor in alcoholic cirrhotics versus nonalcoholics as assessed by triceps skinfold thickness (9.33 ± 2.9 vs 11.64 ± 3.5 mm; P = 0.001), serum albumin (25.1 ± 4 vs 28.1 ± 4 g/L; P = 0.001), and body fat mass (7.6 ± 3.1 vs 8.7 ± 3.3 kg; P = 0.008). Prevalence of malnutrition was 12/27 (44.5%), 96/131 (73.3%) and 84/89 (94.4%) in Child's class A, B, and C respectively. Complications requiring hospitalization (71.3% vs 38.2%; 0.002) and mortality (41.1% vs 18.2%; P = 0.001) were more in malnourished patients compared to well nourished. Nutritional assessment parameters significantly correlated with the liver disease severity (P < 0.05).
  
  
  CONCLUSIONS
  Prevalence of malnutrition is high in patients with cirrhosis. It is associated with increased complications and mortality.
authors.affiliation: Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India.
authors.forename: Sudhir
authors.initials: S
authors.lastname: Maharshi
authors.affiliation: Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India.
authors.forename: Barjesh Chander
authors.initials: BC
authors.lastname: Sharma
authors.affiliation: Department of Gastroenterology, G.B. Pant Hospital, New Delhi, India.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Srivastava
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications; D001823:Body Composition; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000209:etiology* / Q000401:mortality; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000453:epidemiology*; D008875:Middle Aged; D009752:Nutritional Status; D015995:Prevalence; D012720:Severity of Illness Index
keywords: alcoholic liver disease; ascites; encephalopathy