Nutritional Assessment of HCV Related Chronic Liver Disease Egyptian Patients Using New and Standard Methods

Abstract

Over the past years, the role of nutrition as one of the most important factors that can influence overall mortality and morbidity in ESLD has been well understood and appreciated. Without any doubt, liver cirrhosis drives the patients to a catabolic state depriving them of essential nutrients through mechanisms that need to be well understood so that proper actions are taken. Nutritional assessment and correction of the nutrient deficit subsequently can improve the clinical outcome. Identifying the patients that are approaching the state of malnutrition by simple and easily applied methods is necessary in order to provide nutritional support to those that need it. There are different and various methods for nutritional assessment. There are methods that depend on comprehensive history, others depend on clinical and nutritional examination, and others depend on laboratory investigations. Our study was to nutritionally assess Egyptian cirrhotic patients (due to hepatitis C virus) in various stages (according to Child Pugh score) using traditional methods (SGA and anthropometry) and new methods (PNI and CONUT). Ninety patients were included in the study (thirty of each Child group) and all were subjected to careful history (including medical dietary advice, appetite assessment), dietary history (including 24 hour recall and food frequency), clinical examination including (anthropometry), and laboratory investigations to calculate (PNI and CONUT scores). The number of patients with appetite score ≤ 14 was noticed to increase with progress of liver disease. Fasting frequency for investigations in our study wasnot considered a major contributing cause in malnutrition. As regard the nutritional consultation: there was no significant association between weight assessment or meal frequency advice and Child score, but concern about dietary advice increased with progress of liver disease. There was significant relationship between progress of liver disease and restriction of salt, total proteins, red meat and fat. By using anthropometry in nutritional assessment, There was significant association between progress of liver disease and decrease in anthropometric measurements (dry BMI, TSF, MAC, and MAMC), So there was significant relationship between malnutrition assessed by all anthropometric measurements and progress of liver disease. There was a highly significant relationship between progress of malnutrition assessed by (SGA, PNI and CONUT) and progress of liver disease assessed by Child Pugh score. Using SGA as a gold standard method, we found that PNI and CONUT had the same sensitivity and negative predictive value which was 100% but PNI was superior ti CONUT in specificity and negative positive predictive value. As regard results of 24 hour recall method, when relating the results to progress of Child score we found Predominance of unsafe intake in calories, calcium, magnesium, potassium and zinc. This unsafe intake was more in Child C group patients, predominance of unsafe intake was also noted in vitamins, with nearly no significant difference between Child groups. Also we noticed predominance of over consumption in protien, sodium, iron, selenium and copper. This over consumption was more in Child A group patients. When relating the results to progress of PNI score, predominance of unsafe intake was noted in calories, calcium, magnesium, potassium, zinc and vitamins. This unsafe intake was more in severely malnourished patients. Predominance of over consumption was noted in protien, sodium, iron, selenium and copper. This over consumption had no significant relationship with progress of malnutrition among groups. Using food frequency method, we found that frequent consumption of all food items by Child A group patients was more than that by Child C patients, which means that with progress of liver disease, there are less variations with more restrictions and limitations regarding the intake.