Korean J Gastroenterol.  2014 Nov;64(5):284-289. 10.4166/kjg.2014.64.5.284.

Comparison of Malnutrition Risk between Patients with Liver Cirrhosis and Viral Hepatitis Carrier: A Single Center Study

• Lee JA
• Lee TH
• Kim JY
• Seok MG
• Kang MG
• Jeong JH
• Koo HS
• Song KH
• Kim YS
• Kim SM
• Huh KC
• Choi YW
• Kang YW

• KMID: 2164431
• DOI: http://doi.org/10.4166/kjg.2014.64.5.284

Abstract

BACKGROUND/AIMS
It is well-known that patients with chronic liver disease commonly have nutritional deficiency. In the present study, we investigated the differences in malnutrition risk between patients with liver cirrhosis and viral hepatitis carrier.
METHODS
Patients with chronic liver disease who have been hospitalized at Konyang University Hospital from May 2012 to April 2013 were analyzed retrospectively. The malnutrition risk was divided into three categories (low, intermediate, and high) according to Konyang University Hospital Malnutrition Screening, which include BMI, serum albumin, total lymphocyte count (TLC), hemoglobin, weight change, appetite, and dysphagia, within 24 hours of hospitalization.
RESULTS
Among a total of 460 patients, 313 had liver cirrhosis (LC), and 147 were viral hepatitis carriers. Age (p<0.001), serum albumin level (p<0.001), TLC (p=0.011), hemoglobin (p<0.001) and serum cholesterol level (p=0.005) were significant different between the two groups. However, there were no difference in height, weight, and BMI. The malnutrition risk of the patients with viral hepatitis carrier was significantly lower than that of the patients with LC (p<0.001). In addition, among 313 patients with LC, malnutrition risk of the patients with Child-Pugh class A (n=150) was significantly lower than that of the patients with class B (n=90) or C (n=73) (p<0.001).
CONCLUSIONS
Viral hepatitis carrier group had significantly lower malnutrition risk than LC group. The risk of malnutrition in Child-Pugh class A group was significantly lower than that in class B or C group.

Keyword

Hepatitis, viral, human; Liver cirrhosis; Malnutrition

MeSH Terms

Adult
Aged
Body Mass Index
Cholesterol/blood
Female
Hemoglobins/analysis
Hepatitis, Viral, Human/*pathology
Hospitals, University
Humans
Liver Cirrhosis/*pathology
Lymphocyte Count
Male
*Malnutrition
Middle Aged
Nutritional Status
Retrospective Studies
Risk
Serum Albumin/analysis
Severity of Illness Index
Cholesterol
Hemoglobins
Serum Albumin

Reference

References

1. Waitzberg DL, Caiaffa WT, Correia MI. Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients. Nutrition. 2001; 17:573–580.

2. Edington J, Boorman J, Durrant ER, et al. Prevalence of malnutrition on admission to four hospitals in England. The Malnutrition Prevalence Group. Clin Nutr. 2000; 19:191–195.

3. Sungurtekin H, Sungurtekin U, Hanci V, Erdem E. Comparison of two nutrition assessment techniques in hospitalized patients. Nutrition. 2004; 20:428–432.

4. Schneider SM, Veyres P, Pivot X, et al. Malnutrition is an independent factor associated with nosocomial infections. Br J Nutr. 2004; 92:105–111.

5. Pichard C, Kyle UG, Morabia A, Perrier A, Vermeulen B, Unger P. Nutritional assessment: lean body mass depletion at hospital admission is associated with an increased length of stay. Am J Clin Nutr. 2004; 79:613–618.

6. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003; 22:235–239.

7. Tomkins A. Nutrition and maternal morbidity and mortality. Br J Nutr. 2001; 85(Suppl 2):S93–S99.

8. Goiburu ME, Goiburu MM, Bianco H, et al. The impact of malnutrition on morbidity, mortality and length of hospital stay in trau-ma patients. Nutr Hosp. 2006; 21:604–610.

9. Brugler L, Stankovic AK, Schlefer M, Bernstein L. A simplified nutrition screen for hospitalized patients using readily available laboratory and patient information. Nutrition. 2005; 21:650–658.

10. Kim SY, Yeom HS, Park YM, et al. Comparison of tools for nutritional risk screening at hospital admission. J Korean Soc Parenter Nutr. 2009; 2:6–12.

11. Dudrick SJ, Wilmore DW, Vars HM, Rhoads JE. Long-term total parenteral nutrition with growth, development, and positive ni-trogen balance. Surgery. 1968; 64:134–142.

12. Hur H. Nutrition screening and assessment of patients for malnutrition. J Korean Soc Parenter Nutr. 2013; 5:2–9.

13. Mueller C, Compher C, Ellen DM. American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. A.S.P.E.N. clinical guidelines: nutrition screening, assessment, and intervention in adults. J Parenter Enteral Nutr. 2011; 35:16–24.

14. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr. 2003; 22:415–421.

15. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z. Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials. Clin Nutr. 2003; 22:321–336.

16. Kruizenga HM, Van Tulder MW, Seidell JC, Thijs A, Ader HJ, Van Bokhorst-de van der Schueren MA. Effectiveness and cost-ef-fectiveness of early screening and treatment of malnourished patients. Am J Clin Nutr. 2005; 82:1082–1089.

17. Ferguson M, Capra S, Bauer J, Banks M. Development of a valid and reliable malnutrition screening tool for adult acute hospital patients. Nutrition. 1999; 15:458–464.

18. Bauer J, Capra S, Ferguson M. Use of the scored Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition assessment tool in patients with cancer. Eur J Clin Nutr. 2002; 56:779–785.

19. Isenring E, Bauer J, Capra S. The scored Patient-generated Subjective Global Assessment (PG-SGA) and its association with quality of life in ambulatory patients receiving radiotherapy. Eur J Clin Nutr. 2003; 57:305–309.

20. Kim S, Kim S, Sohn C. Development of nutrition screening index for hospitalized patients. Korean J Community Nutr. 2006; 11:779–784.

21. Ritter L, Gazzola J. Nutritional evaluation of the cirrhotic patient: an objective, subjective or multicompartmental approach? Arq Gastroenterol. 2006; 43:66–70.

22. Campillo B, Richardet JP, Scherman E, Bories PN. Evaluation of nutritional practice in hospitalized cirrhotic patients: results of a prospective study. Nutrition. 2003; 19:515–521.

23. Shanbhogue RL, Bistrian BR, Jenkins RL, Jones C, Benotti P, Blackburn GL. Resting energy expenditure in patients with end-stage liver disease and in normal population. J Parenter Enteral Nutr. 1987; 11:305–308.

24. Müller MJ, Böttcher J, Selberg O, et al. Hypermetabolism in clinically stable patients with liver cirrhosis. Am J Clin Nutr. 1999; 69:1194–1201.

25. Meng QH, Wang JH, Yu HW, et al. Resting energy expenditure and substrate metabolism in Chinese patients with acute or chronic hepatitis B or liver cirrhosis. Intern Med. 2010; 49:2085–2091.

26. Verboeket-van de Venne WP, Westerterp KR, van Hoek B, Swart GR. Energy expenditure and substrate metabolism in patients with cirrhosis of the liver: effects of the pattern of food intake. Gut. 1995; 36:110–116.

27. Figueiredo FA, Dickson ER, Pasha TM, et al. Utility of standard nutritional parameters in detecting body cell mass depletion in patients with end-stage liver disease. Liver Transpl. 2000; 6:575–581.

28. Jun DW. Nutrition and chronic liver disease. Hanyang Med Rev. 2011; 31:228–234.

29. Cheung K, Lee SS, Raman M. Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies. Clin Gastroenterol Hepatol. 2012; 10:117–125.

30. Matos C, Porayko MK, Francisco-Ziller N, DiCecco S. Nutrition and chronic liver disease. J Clin Gastroenterol. 2002; 35:391–397.

31. Lee JH, Chae JS, Han KH. Nutritional assessment and management in liver cirrhosis. Korean J Hepatol. 2005; 11:97–105.

32. Alvares-da-Silva MR, Reverbel da Silveira T. Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition. 2005; 21:113–117.

33. Alberino F, Gatta A, Amodio P, et al. Nutrition and survival in patients with liver cirrhosis. Nutrition. 2001; 17:445–450.

34. Peres WA, Lento DF, Baluz K, Ramalho A. Phase angle as a nutritional evaluation tool in all stages of chronic liver disease. Nutr Hosp. 2012; 27:2072–2078.

35. Fernandes SA, Bassani L, Nunes FF, Aydos ME, Alves AV, Marroni CA. Nutritional assessment in patients with cirrhosis. Arq Gastroenterol. 2012; 49:19–27.

36. Korean Liver Cancer Study Group and National Cancer Center. Practice guidelines for management of hepatocellular carcinoma 2009. Korean J Hepatol. 2009; 15:391–423.

37. Detsky AS, McLaughlin JR, Baker JP, et al. What is subjective global assessment of nutritional status? J Parenter Enteral Nutr. 1987; 11:8–13.

38. Guigoz Y, Vellas BJ. Malnutrition in the elderly: the Mini Nutritional Assessment (MNA). Ther Umsch. 1997; 54:345–350.

39. Kruizenga HM, Seidell JC, de Vet HC, Wierdsma NJ, van Bokhorst-de van der Schueren MA. Development and validation of a hospital screening tool for malnutrition: the short nutritional assessment questionnaire (SNAQ). Clin Nutr. 2005; 24:75–82.