Introduction

Malnutrition and sarcopenia are two very frequent complications in patients with liver cirrhosis (LC). These conditions are associated with increased morbidity and mortality, particularly in advanced stages and require early investigation. Despite their significant impact on the prognosis, they are often overlooked and underdiagnosed.

Aims & Methods

Aim: To provide a general overview regarding the nutritional status and dietary intake in patients with LC and highlight any disparities in nutritional parameters between outpatients and hospitalized LC patients.
Methods: In this prospective observational study, all consecutive LC patients attending the portal hypertension clinic and those admitted to the gastroenterology ward at Policlinico Umberto I from May 2023 to January 2024 underwent nutritional screening. Demographic information, clinical characteristics, SARC-F questionnaire, anthropometric measurements, liver frailty index (LFI) parameters, 24-hour diet recall, and food frequency questionnaire were included in the screening. Data was analyzed using Student’s t-test and chi-square test by Jamovi software version 2.3.28.

Results

Altogether 126 patients [male- 72.2%; age 63.7±10.7 years; etiology: Alcohol-53%, MASLD-19%, Viral-20%, Others-8%; MELD- 11.8±4.4; MELD Na- 13.6±5.5; 50% Child A] were enrolled. 36% of the patients were sarcopenic according to SARC-F questionnaire (score ≥ 4), with a mean LFI of 4.6±0.9. Although 65% of the patients consumed at least one protein source daily, only 15% achieved recommended daily protein intake, and 78% had lower energy intake than recommended. Of these 126 patients, 68.3% were outpatient and 31.7% were hospitalized, with comparable age and gender distribution. Hospitalized patients had a lower BMI (kg/m²) [24.7±4.1 vs 27.8±6.9; p=0.01], higher prevalence of frailty [5.1±1.1 vs 4.3±0.7; p=<0.001], lower TSF (mm) [12.4±6.8 vs 16.2±8.1; p=0.04], and lower MUAC (cm) [29.6±5.1 vs 32.2±5.6; p=0.02] than outpatients. Further, none of the hospitalized patients met adequate protein intake, contrasting with 22% of outpatients (p=0.01).

Table 1: Comparison between outpatient and hospitalized patients

Conclusion

​The impairment of nutritional status tend to increase in the more advanced stages of liver disease. There is a need for timely and routine assessment of nutritional status and implementation of targeted lifestyle interventions to optimize patient outcomes.