Observational Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Feb 18, 2017; 9(5): 263-269
Published online Feb 18, 2017. doi: 10.4254/wjh.v9.i5.263
Malnutrition negatively impacts the quality of life of patients with cirrhosis: An observational study
Gabriela Rojas-Loureiro, Alfredo Servín-Caamaño, Elizabeth Pérez-Reyes, Luis Servín-Abad, Fátima Higuera-de la Tijera
Gabriela Rojas-Loureiro, Elizabeth Pérez-Reyes, Fátima Higuera-de la Tijera, Liver Clinic, Gastroenterology Department, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico
Alfredo Servín-Caamaño, Internal Medicine Department, Hospital General de México “Dr. Eduardo Liceaga”, Mexico City 06720, Mexico
Luis Servín-Abad, Gastroenterologist at Lakeland Regional Medical Center, Lakeland, FL 33803, United States
Author contributions: Higuera-de la Tijera F was the guarantor and designed the study; Rojas-Loureiro G, Servín-Caamaño A and Pérez-Reyes E participated in the acquisition, analysis and interpretation of data; Higuera-de la Tijera F wrote the manuscript; Servín-Abad L reviewed the final manuscript and revised the article critically for important intellectual content; all authors read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by The Coordination of Research from Gastroenterology Department from Hospital General de México.
Informed consent statement: All study participants, provided verbal informed consent prior to study enrollment.
Conflict-of-interest statement: The authors involved in this manuscript [Gabriela Rojas-Loureiro, Alfredo Servín-Caamaño, Elizabeth Pérez-Reyes, Luis Servín-Abad, Fátima Higuera-de la Tijera] have no conflicting commercial, personal, political, intellectual or religious interests.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
Correspondence to: Fátima Higuera-de la Tijera, MD, MSc, Liver Clinic, Gastroenterology Department, Hospital General de México “Dr. Eduardo Liceaga”, Dr. Balmis 148, Mexico City 06726, Mexico. fatimahiguera@yahoo.com.mx
Telephone: +52-55-27892000-30047
Received: August 13, 2016
Peer-review started: August 14, 2016
First decision: September 2, 2016
Revised: October 28, 2016
Accepted: December 7, 2016
Article in press: December 9, 2016
Published online: February 18, 2017

To verify how malnutrition is related to health-related quality of life (HRQL) impairment in patients with cirrhosis.


Data was retrospectively abstracted from medical records and obtained by direct interview. We included patients with cirrhosis from any etiology, evaluated at the Liver Clinic from Gastroenterology Department in a tertiary healthcare center, from June 2014 to June 2016. Child-Pugh score, data about complications, and demographic, clinical and anthropometric characteristics of patients were obtained. Nutritional status was evaluated by the Subjective Global Assessment (SGA). HRQL was evaluated through the Chronic Liver Disease Questionnaire. Patients were requested to assess their global HRQL with the following code: 0 = impairment of HRQL, when it was compared with other healthy subjects; 1 = good HRQL, if it was similar to the quality of life of other healthy subjects. To compare the primary outcome between malnourished and well-nourished groups, the χ2 test, Fisher’s exact test or Student’s t-test were used, based on the variable type. Associations between predictor variables and deterioration of HRQL were determined by calculating the hazard ratio and 95% confidence interval using Cox proportional hazards regression.


A total of 127 patients with cirrhosis were included, and the mean age was 54.1 ± 12.3 years-old. According to Child-Pugh scoring, 25 (19.7%) were classified as A (compensated), 76 (59.8%) as B, and 26 (20.5%) as C (B/C = decompensated). According to SGA, 58 (45.7%) patients were classified as well-nourished. Sixty-nine patients identified HRQL as good, and 76 patients (59.8%) perceived impairment of their HRQL. Multivariate analysis to determine associations between predictor variables and self-perception of an impairment of HRQL found strong association with malnutrition (P < 0.0001). The most important impaired characteristics in malnourished patients were: Presence of body pain, dyspnea on exertion with daily activities, decreased appetite, generalized weakness, trouble lifting or carrying heavy objects, and decreased level of energy (P < 0.0001).


Malnutrition is a key factor related to impairment of HRQL in patients with cirrhosis.

Keywords: Malnutrition, Subjective global assessment, Health-related quality of life, Cirrhosis, Chronic liver disease questionnaire

Core tip: Several factors, particularly the severity of disease, development of ascites, need for paracentesis and history of hospitalization for any cause, are factors that worsen the health-related quality of life (HRQL) of patients with cirrhosis. Noteworthy malnutrition is a very important factor which impacts negatively on HRQL of patients suffering cirrhosis; clinicians must recognize it promptly and search for strategies to avoid this preventable comorbidity.