OBJECTIVES

: Malnutrition is predictor of morbidity and mortality in patients with cirrhosis. We investigated prevalence of malnutrition and factors affecting dietary intake in patient with cirrhosis.

METHODS

: Single centre cross sectional observational study. Two hundred fifty one patients with cirrhosis underwent dietary and nutritional assessment by subjective global assessment (SGA) and anthropometric measurement [(dry body mass index (BMI), mid am circumference (MAC), mid arm muscle circumference (MAMC), tricep skin fold thickness (TSF) and handgrip strength (HGS)].Dietary intake assessed in terms of total calories and protein intake, percentage of recommended intake along with per kilogram body weight per day. Factors influencing dietary intake were also assessed.

Results

: Of 251 patients 199(79%) were males and 52 (21%) were female {mean age 51±14 yrs, Child's A: B: C:: 83:116:52}. SGA analysis 87(35%) were well nourished (SGA-A), 106(42%) moderately nourished (SGA-B) and 58(23%) severely malnourished (SGA-C). Child's C patients were severely malnourished compared to Child's B and A. MAC, MAMC, TSF and HGS was significantly higher in SGA-A compared to SGA-B and SGA-C.

Patients in SGA-A(1939±479 kcal/d) consumed significantly higher calories than SGA-B(1494±216kcal/d) and SGA-C(1321±213kcal/d).Percentage of recommended calories intake {SGA-A(76%),SGA-B(61%) and SGA-C(59%),P=0.001} and calories/kg/d is also higher in SGA-A compared to SGA-B and C. Similar were the results with protein intake{SGA-A(61±14gm/d),SGA-B(56±7gm/d) and SGA-C(51±9gm/d),p=0.001}.Protein intake in gm/kg/d is significantly lower in SGA-C (0.76±0.22) compared to SGA-B (0.85±0.2) and SGA-A (0.93±0.2). 61% patients were vegetarian and 84% did not take evening snacks. Poor appetite (n=68, 27%), early satiety (n=75, 30%), abdominal fullness (n=62, 25%), low salt diet (n=52, 21%) and social myth about diet 43(17%) were the common reason of poor intake. Distension of abdomen, social myth about diet and low sodium in diet were key factors affecting dietary intake in patients with cirrhosis and malnutrition.

Conclusion

: Malnutrition seen in 65% of patients. Total calories and protein intake was significantly low compared to recommendation even in well nourished patients. Distension of abdomen, social myth about diet and low sodium in diet were key factors affecting dietary intake in patients with cirrhosis and malnutrition.