Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Oct 27, 2020; 12(10): 829-840
Published online Oct 27, 2020. doi: 10.4254/wjh.v12.i10.829
Malnutrition and non-compliance to nutritional recommendations in patients with cirrhosis are associated with a lower survival
Dana Crisan, Bogdan Procopet, Alexandra Epure, Horia Stefanescu, Alina Suciu, Andreea Fodor, Emil Mois, Rares Craciun, Nicolae Crisan
Dana Crisan, Nicolae Crisan, Internal Medicine Department, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400126, Romania
Bogdan Procopet, Alexandra Epure, Alina Suciu, Andreea Fodor, 3rd Medical Clinic, “Iuliu Hatieganu” University of Medicine and Pharmacy, Cluj-Napoca 400126, Romania
Bogdan Procopet, Horia Stefanescu, Hepatology Unit, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400162, Romania
Emil Mois, Surgery Department, “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400126, Romania
Rares Craciun, Hepatology Unit , “Prof. Dr. Octavian Fodor” Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca 400126, Romania
Author contributions: Crisan D, Procopet B, Stefanescu H and Crisan N had key contributions in the conception and design of the study and have provided a critical revision of the manuscript for important intellectual content; Epure A, Suciu A, Fodor A and Mois E have performed the nutritional assessment; have applied the nutritional recommendations adherence questionnaires and worked on data acquisition; Crisan D, Procopet B and Craciun R have contributed to analysis and interpretation of the data and drafting the manuscript; all authors gave their final approval of the version to be submitted and agree to be accountable for all aspects of the work.
Institutional review board statement: The study was reviewed and approved by the “Iuliu Hatieganu” University of Medicine and Pharmacy.
Informed consent statement: Participants were informed about the plan about our study details. And if they agreed to participate in, written informed consent was obtained from each participant prior to their inclusion in the study.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement checklist of items and prepared and revised the manuscript accordingly.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Bogdan Procopet, MD, PhD, Doctor, Senior Lecturer, Staff Physician, 3rd Medical Clinic, “Iuliu Hatieganu” University of Medicine and Pharmacy, 19-21 Croitorilor Street, Cluj-Napoca 400126, Romania. bogdan.procopet@umfcluj.ro
Received: May 25, 2020
Peer-review started: May 25, 2020
First decision: June 12, 2020
Revised: July 6, 2020
Accepted: September 4, 2020
Article in press: September 4, 2020
Published online: October 27, 2020
Abstract
BACKGROUND

Malnutrition is frequently encountered in patients with cirrhosis and appears to significantly impact their prognosis. While evaluating the burden of malnutrition in cirrhosis is gathering momentum, as suggested by multiple recently published reports, there is still a persistent scarcity of solid data in the field, especially with regards to the role of nutritional interventions.

AIM

To assess the prevalence of malnutrition in patients with advanced cirrhosis and to evaluate its impact on survival.

METHODS

One hundred and one consecutive patients with advanced cirrhosis were screened for malnutrition using the Subjective Global Assessment (SGA) criteria and the mid-arm circumference (MAC). Malnutrition was defined as SGA class B and C and MAC < 10th percentile. All patients were interviewed regarding their food intake using an adapted questionnaire. Subsequently, total energy intake was calculated and further subdivided in main nutrients. The data were then compared to the available recommendations at the time of analysis to assess adherence.

RESULTS

54/79 patients (68.4%) in the decompensated group had malnutrition, while only 3/22 patients (13.6%) were malnourished in the compensated group. After a median follow-up time of 27 mo (0-53), the overall mortality was 70%. Survival was significantly lower among patients with malnutrition. The mortality rates were 50% at 1 year and 63% at 2 years for the patients with malnutrition, compared to 21% at 1 year and 30% at 2 years for patients without malnutrition (P = 0.01). On multivariate analysis, the factors independently associated with mortality were age, creatinine level and adherence to the protein intake recommendations. The mortality was lower in patients with the appropriate protein intake: 8% at 1 year and 28% at 2 years in the adherent group, compared to 47% at 1 year and 56% at 2 years in the non-adherent group.

CONCLUSION

The prevalence of malnutrition is high among patients with advanced cirrhosis and might be related in part to a low adherence to nutritional recommendations, especially with regards to protein intake.

Keywords: Malnutrition, Decompensated cirrhosis, Survival, Subjective global assessment, Protein intake

Core Tip: It is already known that the patients having cirrhosis can be affected by malnutrition and this status can impact the survival. This article studied the prevalence of malnutrition in advanced stages of cirrhosis, and its influence on survival. Our results showed that the prevalence of malnutrition is high in patients with advanced cirrhosis and is related in part to a low adherence to nutritional recommendations. Appropriate protein intake could increase the survival.