Malnutrition and non-compliance to nutritional recommendations in patients with cirrhosis are associated with a lower survival
| Autor: | Alexandra Epure, Horia Stefanescu, Nicolae Crisan, Alina Suciu, Rares Craciun, Dana Crisan, Emil Mois, Andreea Fodor, Bogdan Procopet |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Percentile Multivariate analysis Cirrhosis Survival Observational Study Decompensated cirrhosis 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Internal medicine Medicine Subjective global assessment In patient Creatinine Hepatology business.industry Mortality rate Malnutrition medicine.disease Protein intake chemistry 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology business |
| Zdroj: | World Journal of Hepatology |
| ISSN: | 1948-5182 |
| DOI: | 10.4254/wjh.v12.i10.829 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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