title: Factors Associated With Protein-energy Malnutrition in Chronic Liver Disease: Analysis Using Indirect Calorimetry.
abstract: We aimed to elucidate the incidence of protein-energy malnutrition (PEM) in patients with chronic liver disease and to identify factors linked to the presence of PEM.A total of 432 patients with chronic liver disease were analyzed in the current analysis. We defined patients with serum albumin level of ≤3.5 g/dL and nonprotein respiratory quotient (npRQ) value using indirect calorimetry less than 0.85 as those with PEM. We compared between patients with PEM and those without PEM in baseline characteristics and examined factors linked to the presence of PEM using univariate and multivariate analyses.There are 216 patients with chronic hepatitis, 123 with Child-Pugh A, 80 with Child-Pugh B, and 13 with Child-Pugh C. Six patients (2.8%) had PEM in patients with chronic hepatitis, 17 (13.8%) in patients with Child-Pugh A, 42 (52.5%) in patients with Child-Pugh B, and 10 (76.9%) in patients with Child-Pugh C (P < 0.001). Multivariate analysis revealed that Child-Pugh classification (P < 0.001), age ≥64 years (P = 0.0428), aspartate aminotransferase (AST) ≥40 IU/L (P = 0.0023), and branched-chain amino acid to tyrosine ratio (BTR) ≤5.2 (P = 0.0328) were independent predictors linked to the presence of PEM. On the basis of numbers of above risk factors (age, AST, and BTR), the proportions of patients with PEM were well stratified especially in patients with early chronic hepatitis or Child-Pugh A (n = 339, P < 0.0001), while the proportions of patients with PEM tended to be well stratified in patients with Child-Pugh B or C (n = 93, P = 0.0673).Age, AST, and BTR can be useful markers for identifying PEM especially in patients with early stage of chronic liver disease.
authors.affiliation: From the Division of Hepatobiliary and Pancreatic disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Nishikawa
authors.forename: Kazunori
authors.initials: K
authors.lastname: Yoh
authors.forename: Hirayuki
authors.initials: H
authors.lastname: Enomoto
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Iwata
authors.forename: Kyohei
authors.initials: K
authors.lastname: Kishino
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Shimono
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Hasegawa
authors.forename: Chikage
authors.initials: C
authors.lastname: Nakano
authors.forename: Ryo
authors.initials: R
authors.lastname: Takata
authors.forename: Takashi
authors.initials: T
authors.lastname: Nishimura
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Aizawa
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Sakai
authors.forename: Naoto
authors.initials: N
authors.lastname: Ikeda
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Takashima
authors.forename: Akio
authors.initials: A
authors.lastname: Ishii
authors.forename: Hiroko
authors.initials: H
authors.lastname: Iijima
authors.forename: Shuhei
authors.initials: S
authors.lastname: Nishiguchi
mesh_terms: D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D002153:Calorimetry, Indirect / Q000379:methods; D016022:Case-Control Studies; D002908:Chronic Disease; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008107:Liver Diseases / Q000175:diagnosis* / Q000453:epidemiology*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011502:Protein-Energy Malnutrition / Q000175:diagnosis* / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D013997:Time Factors