Assessment of Nutritional Status of Patients with Chronic Hepatitis C and HCV-Related Cirrhosis in the Compensated Stage
American Journal of Internal Medicine
Volume 4, Issue 2, March 2016, Pages: 24-35
Received: Feb. 15, 2016; Accepted: Feb. 23, 2016; Published: Mar. 8, 2016
Views 4153      Downloads 130
Authors
Hoda M. Amin, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Rasha M. Abdel Samie, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
Fardous S. Hamed, Clinical Nutrition Department, National Nutrition Institute, Cairo, Egypt
Ebtehal M. Abo Zaid, Internal Medicine Department, Faculty of Medicine, Cairo University, Cairo, Egypt
El Sayed M. Hammad, Clinical Nutrition Department, National Nutrition Institute, Cairo, Egypt
Article Tools
Follow on us
Abstract
Background and Aim: Malnutrition is prevalent among patients with chronic liver disease. We aimed to assess the nutritional status of HCV-related compensated cirrhosis and chronic HCV-infected patients compared to healthy control subjects and to compare the different methods used for nutritional assessment namely the anthropometric measures and the Subjective Global Assessment (SGA). Patients and Methods: A total of 120 subjects were recruited. 40 patients with hepatitis C- related compensated liver cirrhosis in Group I, 40 patients with chronic hepatitis C in Group II and 40 age - and sex- matched healthy Egyptian volunteers in Group III. Thorough history taking, physical examination and detailed nutritional assessment were performed including a 24- hour dietary recall. Evaluation of nutritional status was done using different anthropometric measures and the Subjective Global Assessment (SGA). Results: Chronic HCV patients were found to have lower mean daily caloric intake (1858.70±630.2 Kcal/day) as compared to patients with compensated cirrhosis (1923.75±595.8 Kcal/day). The diagnosis of severely malnourished was detected with an increased frequency in the cirrhotic patients by the triceps skin fold thickness (TST) method (52.5%) as compared to mid-arm muscle circumference (MAMC) (30%) and the sub-scapular skin fold thickness (15%). In the chronic HCV patients, an increased frequency of diagnosis of malnutrition was detected by the MAMC% (57.5%) as compared to the other anthropometric indices. Based on the SGA rating, moderate degree of malnutrition was detected in 37.5% of cirrhotic patients and only 27.5% of chronic HCV patients, however, severe degree of malnutrition was not diagnosed in any of the subjects. The majority of the patients with compensated HCV related cirrhosis and chronic HCV group as well as controls were found to be overweight 67.5%, 62.5% and 62.5% respectively. There was a highly significant positive correlation between the BMI and the TST, MAC, MAMC, and sub-scapular skin fold thickness in the three studied groups. Conclusion: Overweight was prevalent among patients with chronic HCV and compensated cirrhosis. SGA underestimated the degree and prevalence of malnutrition as compared to TST, MAMC and sub-scapular skin fold thickness in the liver cirrhosis, chronic hepatitis C and healthy control groups.
Keywords
Chronic HCV-compensated Cirrhosis-SGA-TST- MAMC
To cite this article
Hoda M. Amin, Rasha M. Abdel Samie, Fardous S. Hamed, Ebtehal M. Abo Zaid, El Sayed M. Hammad, Assessment of Nutritional Status of Patients with Chronic Hepatitis C and HCV-Related Cirrhosis in the Compensated Stage, American Journal of Internal Medicine. Vol. 4, No. 2, 2016, pp. 24-35. doi: 10.11648/j.ajim.20160402.11
Copyright
Copyright © 2016 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
References
[1]
Italian Multicentre Cooperative Project on Nutrition in Liver Cirrhosis. Nutritional status in cirrhosis. J Hepatol. 1994; 21: 317-25.
[2]
Muller MJ. Malnutrition in cirrhosis. J Hepatol. 1995; 23: 31–35.
[3]
Lautz HU, Selberg O, Korber J, Bürger M, Müller MJ. Protein- calorie malnutrition in liver cirrhosis. Clin Investig. 1992; 70: 478-86.
[4]
Guglielmi FW, Panella C, Buda A et al. “Nutritional state and energy balance in cirrhotic patients with or without hypermetabolism. Multicentre prospective study by the “Nutritional Problems in Gastroenterology” Section of the Italian Society of Gastroenterology (SIGE),” Digestive and Liver Disease, 2005; 37(9): 681–688.
[5]
DiCecco SR, Wieners EJ, Wiesner RH, Southorn PA, Plevak DJ, Krom RA. Assessment of nutritional status of patients with end stage liver disease undergoing liver transplantation. Mayo Clin Proc 1989; 64: 95-102.
[6]
Shepard CW, Finelli L, Alter MJ. Global epidemiology of hepatitis C virus infection. Lancet Infect Dis. 2005; 5: 558–67.
[7]
Roongpisuthipong C, Sobhonslidsuk A, Nantiruj K, Songchitsomboon S. Nutritional assessment in various stages of liver cirrhosis. Nutrition 2001; 17: 761-5.
[8]
Vieira PM, De-Souza DA and Oliveira LCM. Nutritional assessment in hepatic cirrhosis; clinical, anthropometric, biochemical and haematological parameters. Nutr Hosp. 2013; 28(5): 1615-1621.
[9]
Cheung K, Lee SS and Raman M. Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies. Clin Gastroenterol Hepatol 2012; 10: 117-25.
[10]
Balbino V, Castro e Silva O. Nutritional assessment of cirrhotic patients: A new approach based on electrical bioimpedance. Medicina (Ribeirăo Preto) 2012; 45(1): 1-4.
[11]
Yasutake K, Bekki M, Ichinose M, Ikemoto M, Fujino T, Ryu T, Wada Y, Takami Y, Saitsu H. Assessing current nutritional status of patients with HCV-related liver cirrhosis in the compensated stage. Asia Pac J Clin Nutr 2012; 21 (3): 400-405.
[12]
Alveras-da-Silva MR, Reverbel da Silveira T. Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition 2005; 21: 113–7.
[13]
Bragança ACC and Álvares-da-Silva MR. Prevalence of diabetes mellitus and impaired glucose tolerance in patients with decompensated cirrhosis being evaluated for liver transplantation: the utility of oral glucose tolerance test. Arq Gastroenterol. 2010; 47(1): 22-7.
[14]
Carvalho L and Parise ER. Evaluation of nutritional status of nonhospitalized patients with liver cirrhosis. Arq Gastroenterol. 2006; 43(4): 269-74.
[15]
Ferreira LG, Anastácio LR, Lima AS, Correia MITD. Desnutrição e inadequação alimentar de pacientes aguardando transplante hepático. Rev Assoc Med Brás. 2009; 55(4): 389-93.
[16]
Gottschall CBA, Nunes FF, Aydos MED, Bragança AC, Felix DR, Rabito EI, Álvares-da-Silva MR. Contribution of dynamometry and the royal free hospital global assessment to the nutritional assessment of patients with chronic liver diseases. Rev Chil Nutr. 2012; 39(4): 152-8.
[17]
Peng S, Plank LD, McCall, JL, Gillanders LK, McIlroy K, Gane E. Body com¬position, musclefunction, and energy expenditure in patients with liver cirrhosis: a comprehensive study. Am J Clin Nutr. 2007; 85: 1257-66.
[18]
Ismail FW, Khan` RA, Kamani L, Wadalawala AA, Shah HA, Hamid SS, Jafri W. Nutritional status in patients with hepatitis C. J Coll Physicians Surg Pak. 2012; 22(3): 139-42.
[19]
Muto Y, Sato S, Watanabe A, Moriwaki H, Suzuki K, Kato A, et al. Overweight and obesity increase the risk for liver cancer in patients with liver cirrhosis and long-term oral supplementation with branched-chain amino acid granules inhibits liver carcinogenesis in heavier patients with liver cirrhosis. Hepatol Res. 2006; 35: 204-14.
[20]
Poon RT, Yu WC, Fan ST, Wong J. Long-term oral branched chain amino acids in patients undergoing chemoembolization for hepatocellular carcinoma: a randomized trial. Aliment Pharmacol Ther. 2004; 19: 779-88.
[21]
Nakaya Y, Okita K, Suzuki K, Moriwaki H, Kato A, Miwa Y, et al. BCAA-enriched snack improves nutritional state of cirrhosis. Nutrition. 2007; 23: 113-20.
[22]
Aoyama K, Tsuchiya M, Mori K, Kubo Y, Shiraishi K, Sakaguchi E, Yamashita S, Sakaida I. Effect of a late evening snack on outpatients with liver cirrhosis. Hepatol Res. 2007; 37: 608-14.
[23]
World Medical Association. "Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects". JAMA 2013; 310 (20): 2191–2194.
[24]
Anthropometric Reference Data for Children and Adults: United States, 1988 – 1994, based on data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-94).
[25]
Blackburn GL, Harvey KB. Nutritional assessment as a routine in clinical medicine. Postgrad Med 1982; 71: 46-63.
[26]
National Nutrition Institute (2006) Food Composition Tables for Egypt. 2nd Edition, ARE, Cairo, 119.
[27]
Food and Nutrition Board, Institute of Medicine: Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients) Washington, DC: National Academy Press, 2005.
[28]
Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 1987; 11: 8- 13.
[29]
Baker JP, Detsky AS, Wesson DE et al. “Nutritional assessment: a comparison of clinical judgement and objective measurements,” New England Journal of Medicine, 1982; 306(16): 969–972.
[30]
Tai ML, Goh KL, Mohd-Taib SH, Rampal S, Mahadeva S. Anthropometric, biochemical and clinical assessment of malnutrition in Malaysian patients with advanced cirrhosis. Nutr J 2010; 9: 1-7.
[31]
Hasse J, Strong S, Gorman MA, Liepa G. Subjective global assessment: alternative nutrition-assessment technique for liver-transplant candidates. Nutrition 1993; 9: 339-43.
[32]
Covinsky KE et al. ‘‘The relationship between clinical assessments of nutritional status and adverse outcomes in older hospitalized medical patients’’, Journal of American Geriatric Society. 1999; 47: 532-8.
[33]
Canadian guidelines for Health Care Providers. Hepatitis C: Nutrition Care. Dietitians of Canada, 2003.
[34]
World Health Organization, Geneva. Weekly Epidemiological Record. 1997; 46: 341-8.
[35]
Gottschall, CBA, Álvares-da-Silva MR, Camargo ACR, Burtett RM, Silveira TR. Nutritional assessment in patients with cirrhosis: the use of indirect calorimetry. Arq Gastroenterol. 2004; 41(4): 220-4.
[36]
Alberino F, Gatta A, Amodio P, Merkel C, Di Pascoli L, Boffo G, et al. Nutrition and survival in patients with liver cirrhosis. Nutrition 2001; 17: 445-50.
[37]
Caregaro L, Alberino F, Amodio P, Merkel C, Bolognesi M, Angeli P, et al. Malnutrition in alcoholic and virus-related cirrhosis. Am J Clin Nutr 1996; 63: 602-9.
[38]
Campillo B, Richardet J-P, Scherman E, et al. Evaluation of nutritional practice in hospitalized cirrhotic patients: results of a prospective study. Nutrition 2003; 19: 515-521.
[39]
O’Brien A and Williams R. Nutrition in end-stage liver disease: principles and practice. Gastroenterology 2008; 134: 1729-1740.
[40]
Singh N, Choudhary JK, Srivastava M, Tripathi MK, Rungta S, Singh SK, Jain AK, Dixit VK. Nutritional And Clinical Profile Of Patients In Different Stages Of Alcoholic And Virus Related Liver Disease: An Indian Perspective. Webmed Central plus GASTROENTEROLOGY 2013: WMCPLS00239.
[41]
Butt S, Ahmed P, Liaqat P and Ahmad H. A study of malnutrition among chronic liver disease patients. Pakistan Journal of Nutrition 2009; 8(9): 1465-1471.
[42]
Gottschall CBA, Pereira TG, Rabito EI, Álvares-da-Silva MR. Nutritional status and dietary intake in non-cirrhotic adult chronic hepatitis C patients. Arq Gastroenterol 2015; 52(3): 204-9.
[43]
Schmidt MI, Duncan BB, Silva GA, Menezes AN, Monteiro CA, Barreto SM, Chor D, Menezes PR. Chronic non-communicable diseases in Brazil: burden and current challenges. Lancet. 2011; 9; 61-74.
[44]
Norman K, Valentini L, Lochs H, Pirlich M. Protein Catabolism and Malnutrition in Liver Cirrhosis - Impact of Oral Nutritional Therapy. Z Gastroenterol 2010; 48 (7): 763-70.
[45]
Merli M, Riggio O, Dally L. Does malnutrition affect survival in cirrhosis? PINC (Policentrica Italiana Nutrizione Cirrosi). Hepatology, 1996; 23: 1041-1046.
[46]
Henkel AS and Buchman AL. Nutritional support in patients with chronic liver disease. Nat Clin Pract Gastroenterol Hepatol 2006; 3: 202-9.
[47]
Plauth M, Cabre E, Riggio O et al. ESPEN Guidelines on Enteral Nutrition: Liver disease. Clinical Nutrition, 2006; 25: 285-294.
[48]
Stephenson GR, Moretti EW, El-Moalem H, et al. Malnutrition in liver transplant patients: preoperative subjective global assessment is predictive of outcome after liver transplantation. Transplantation 2001; 27: 666-670.
[49]
Plauth M, Merli M, Kondrup J, Weimann A, Ferenci P, Müller MJ. ESPEN Consensus Group. Guidelines for nutrition in liver disease and transplantation. Clin Nutr 1997; 16: 43-55.
[50]
Figueiredo FAF, Perez RM, Freitas MM, and Kondo M. “Comparison of threemethods of nutritional assessment in liver cirrhosis: subjective global assessment, traditional nutritional parameters, and body composition analysis,” Journal of Gastroenterology 2006; 41(5): 476–482.
[51]
Fernandes SA, Bassani L, Nunes FF, Aydos MED, Alves AV, Marroni CA. Nutritional Assessment in patients with cirrhosis. Arq Gastroenterol 2012; 49: 19-27.
[52]
Gunsar F, Raimondo ML, Jones S, et al. Nutritional status and prognosis in cirrhotic patients. Aliment Pharmacol Ther. 2006; 24: 563-572.
ADDRESS
Science Publishing Group
1 Rockefeller Plaza,
10th and 11th Floors,
New York, NY 10020
U.S.A.
Tel: (001)347-983-5186