Impaired nutritional status, frailty and inadequate dietary intake: a reality still underdiagnosed in liver cirrhosis patients

Abstract

Introduction

Malnutrition and frailty are common in liver cirrhosis (LC) patients, increasing morbidity and mortality, especially in advanced stages. Despite their impact on prognosis, they are often overlooked and underdiagnosed.

Aim

To provide an overview of the nutritional status, frailty and dietary intake in LC patients, both outpatients and hospitalized, enrolled in a recent cross-sectional study before starting nutritional counselling.

Materials and Methods

In this prospective observational study, all consecutive LC patients attending the portal hypertension clinic and/or admitted to the gastroenterology unit at Policlinico Umberto I University Hospital from May 2023-January 2024 underwent nutritional screening. Screening included SARC-F questionnaire for sarcopenia, anthropometric measurements, liver frailty index (LFI) assessment, 24-hour diet recall, and food frequency questionnaire. Data were analyzed using Student's t-test and chi-square test by Jamovi software V2.3.28.

Results

Altogether 126 patients [72% male; age 63.7±10.7years; 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. According to SARC-F questionnaire, 36% were sarcopenic (score ≥4) and > 90% were frail or pre-frail (mean LFI 4.6±0.9). Although 65% patients consumed at least one protein source daily, 85% failed to achieve recommended daily protein intake, and 78% had lower than recommended caloric intake. Of the cohort, 68.3% were outpatient and 31.7% were hospitalized patients, with comparable age and gender distribution. Hospitalized patients had lower BMI(kg/m²) [24.7±4.1 vs 27.8±6.9;p=0.01], higher frailty scores [LFI 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).

Conclusion

There is still a high need for timely assessment of nutritional status, frailty and dietary intake in all chronic liver disease patients. This is true for both more severe hospitalized patients and outpatients and represents the premise for planning further lifestyle interventions to optimize patient outcomes.