title: Nutritional care in hospitalized patients with chronic liver disease.
abstract: OBJECTIVE
  To evaluate the practice of nutritional assessment and management of hospitalised patients with cirrhosis and the impact of malnutrition on their clinical outcome.
  
  
  METHODS
  This was a retrospective cohort study on patients with liver cirrhosis consecutively admitted to the Department of Gastroenterology and Hepatology at the Royal Adelaide Hospital over 24 mo. Details were gathered related to the patients' demographics, disease severity, nutritional status and assessment, biochemistry and clinical outcomes. Nutritional status was assessed by a dietician and determined by subjective global assessment. Estimated energy and protein requirements were calculated by Simple Ratio Method. Intake was estimated from dietary history and/or food charts, and represented as a percentage of estimated daily requirements. Median duration of follow up was 14.9 (0-41.4) mo.
  
  
  RESULTS
  Of the 231 cirrhotic patients (167 male, age: 56.3 ± 0.9 years, 9% Child-Pugh A, 42% Child-Pugh B and 49% Child-Pugh C), 131 (57%) had formal nutritional assessment during their admission and 74 (56%) were judged to have malnutrition. In-hospital caloric (15.6 ± 1.2 kcal/kg vs 23.7 ± 2.3 kcal/kg, P = 0.0003) and protein intake (0.65 ± 0.06 g/kg vs 1.01 ± 0.07 g/kg, P = 0.0003) was significantly reduced in patients with malnutrition. Of the malnourished cohort, 12 (16%) received enteral nutrition during hospitalisation and only 6 (8%) received ongoing dietetic review and assessment following discharge from hospital. The overall mortality was 51%, and was higher in patients with malnutrition compared to those without (HR = 5.29, 95%CI: 2.31-12.1; P < 0.001).
  
  
  CONCLUSIONS
  Malnutrition is common in hospitalised patients with cirrhosis and is associated with higher mortality. Formal nutritional assessment, however, is inadequate. This highlights the need for meticulous nutritional evaluation and management in these patients.
authors.affiliation: Dep K Huynh, Shane P Selvanderan, Hugh AJ Harley, Richard H Holloway, Nam Q Nguyen, Discipline of Medicine, University of Adelaide, North Terrace, Adelaide 5000, South Australia, Australia.
authors.forename: Dep K
authors.initials: DK
authors.lastname: Huynh
authors.affiliation: Dep K Huynh, Shane P Selvanderan, Hugh AJ Harley, Richard H Holloway, Nam Q Nguyen, Discipline of Medicine, University of Adelaide, North Terrace, Adelaide 5000, South Australia, Australia.
authors.forename: Shane P
authors.initials: SP
authors.lastname: Selvanderan
authors.affiliation: Dep K Huynh, Shane P Selvanderan, Hugh AJ Harley, Richard H Holloway, Nam Q Nguyen, Discipline of Medicine, University of Adelaide, North Terrace, Adelaide 5000, South Australia, Australia.
authors.forename: Hugh A J
authors.initials: HA
authors.lastname: Harley
authors.affiliation: Dep K Huynh, Shane P Selvanderan, Hugh AJ Harley, Richard H Holloway, Nam Q Nguyen, Discipline of Medicine, University of Adelaide, North Terrace, Adelaide 5000, South Australia, Australia.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Holloway
authors.affiliation: Dep K Huynh, Shane P Selvanderan, Hugh AJ Harley, Richard H Holloway, Nam Q Nguyen, Discipline of Medicine, University of Adelaide, North Terrace, Adelaide 5000, South Australia, Australia.
authors.forename: Nam Q
authors.initials: NQ
authors.lastname: Nguyen
mesh_terms: D002908:Chronic Disease; D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D018529:Nutritional Support / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013021:South Australia; D013997:Time Factors; D016896:Treatment Outcome
keywords: Liver cirrhosis; Malnutrition; Morbidity; Mortality; Nutrition assessment