NUTRITIONAL ASSESSMENT AND ADEQUACY OF DIETARY-INTAKE IN HOSPITALIZED-PATIENTS WITH ALCOHOLIC LIVER-CIRRHOSIS

Nutritional assessment and adequacy of spontaneous dietary intake was evaluated in thirty-seven clinically stable hospitalized patients with alcoholic liver cirrhosis. About two-thirds of the patients had ascit es or oedema, or both, and, therefore, body weight could not be used f or assessment of nutritional status. Lean body mass (LBM; measured by three consecutive 24 h creatinine excretions) was 62 (range 40-95)% of reference values, mid-arm-muscle area (MAMA) was 70 (range 43-115)% a nd triceps skinfold (TSF) was 45 (range 20-113)% of reference values ( all median values). In patients without ascites or oedema, or both, th ere was a rectilinear correlation between body weight and LBM and betw een body weight and MAMA (r 0.93 and 0.85 respectively). In patients w ith ascites or oedema, or both, the correlation between body weight an d LBM was poor as could be expected. We suggest that LBM is a useful m easure of nutritional status when body weight is unreliable because of ascites or oedema, or both. Energy balance for the group was calculat ed from energy intake recorded by a 24 h dietary recall and energy exp enditure calculated by the factorial method. Median intake was 102 (ra nge 34-176)% of expenditure. N loss was calculated from the average of three 24 h urea excretions. Protein intake was calculated from the 24 h dietary recall. The N balance was positive in the patients as a gro up (median intake was 120 (range 26-183)% of output). The most malnour ished patients tended to have the most positive N balance which was du e to a significantly lower N excretion. The protein requirement for N balance was 0.83 (SE 0.05) g/kg per d and only at an intake above 1.20 g/kg per d were all patients in positive N balance. The median intake s of thiamin, folacin, vitamin D, vitamin E, Mg, and Zn were judged to be insufficient. It is concluded that impaired nutritional status is common among patients with liver cirrhosis, even in a stable clinical condition. It is suggested that nutritional status in these patients i s evaluated by dietary recalls, in combination with measurement of bod y weight in patients without ascites or oedema, or both, or in combina tion with determination of LBM by three 24 h creatinine excretions in patients with ascites or oedema, or both. Criteria for selection of pa tients that might benefit from nutritional therapy are discussed.