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The clinical investigator

, Volume 70, Issue 6, pp 478–486 | Cite as

Protein-calorie malnutrition in liver cirrhosis

  • H. U. Lautz
  • O. Selberg
  • J. Körber
  • M. Bürger
  • M. J. Müller
Original Article

Summary

The purpose of this article is to present detailed data on the nutritional assessment in cirrhotic patients. The exact frequency and types of malnutrition, its associations with the aetiology of liver disease, liver dysfunction and clinical staging in liver cirrhosis are unknown. A new classification system is presented which may help to suggest some interventional guidelines. Physical (anthropometry, 24-h urinary creatinine excretion, bioelectrical impedance analysis (BIA), total body potassium counting, ultrasound examination) and metabolic (indirect calorimetry) assessment of nutritional status was therefore performed in 123 patients with liver cirrhosis, who were considered as potential candidates for liver transplantation. Data were related to the clinical, biochemical, histological and prognostic data of liver disease. Of our patients 65% showed some signs of protein-calorie malnutrition as indicated by low body cell mass, reduced serum albumin concentrations or abnormal skinfold thickness. Of these 34% were considered as “kwashiorkor-like” (normal body composition, serum albumin <35 g/1), and 18% were “marastic” (reduced body weight, body cell mass, and fat mass). However, 49% of the malnourished group had reduced body cell mass in association with increased fat mass and frequently presented with a normal body weight (“mixed” or “obese” type). Protein-calorie malnutrition did not correlate with the aetiology of the disease and biochemical parameters of liver function. Malnutrition was observed at all clinical stages but was more frequently seen at advanced stages. We conclude that malnutrition associated with liver cirrhosis is not a clear phenomenon. Its clinical presentation is heterogenous and not reflected by the histological or biochemical parameters of liver disease. Since malnutrition is rarely diagnosed, early and detailed nutritional assessment in all patients with liver disease is important.

Key words

Liver cirrhosis Liver transplantation Malnutrition Nutritional state Marasmus Kwashiorkor Nutritional assessment Liver function Energy expenditure 

Abbreviations

AMA

arm muscle area

ALT

alanine aminotransferase

AST

aspartate aminotransferase

BCM

body cell mass

BIA

bioelectrical impedance analysis

BMI

body mass index

BW

body weight

CHE

cholinesterase

FFM

fat free mass

ICG

indocyanine green

LBM

lean body mass

MAC

mid-arm circumference

MEGX

monoethylglycinexylidide

PTT

prothrombin time

TBP

total body potassium

TSF

triceps skinfold

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Copyright information

© Springer-Verlag 1992

Authors and Affiliations

  • H. U. Lautz
    • 1
  • O. Selberg
    • 1
  • J. Körber
    • 2
  • M. Bürger
    • 1
  • M. J. Müller
    • 1
  1. 1.Medizinische Hochschule Hannover, Zentrum Innere Medizin, Abteilung Gastroenterologie and HepatologieHannover
  2. 2.Rudolf Virchow KrankenhausBerlin

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