Nutrition and survival in patients with liver cirrhosis

Although the effect of malnutrition on survival has been demonstrated by a number of studies, it is not clear whether malnutrition represents an indep endent risk factor in patients with liver disease. We studied 212 hospitali zed patients with liver cirrhosis who were followed clinically for 2 y or u ntil death. Body fat and muscle mass were evaluated by triceps skinfold thi ckness (TSF) and midarm muscle circumference (MAMC), respectively. Multivar iate analysis according to Cox's model assessed the predictive power of nut ritional parameters on survival. Thirty-four percent of patients had severe malnutrition as determined by MAMC and/or TSF below the 5th percentile and 20% had moderate malnutrition (MAMC and/or TSF < 10th percentile). Twenty- six percent of patients were overnourished (MAMC and/or TSF > 75th pecentil e). Severely and moderately malnourished patients had lower survival rates than normal and overnourished patients. When analyzed with Cox's regression analysis, severe depletion of muscle mass and body fat were found to be in dependent predictors of survival. The inclusion of MAMC and TSF in the Chil d-Pugh score, the prognostic score used most with liver disease, improved i ts prognostic accuracy. The prognostic power of MAMC was higher than that o f TSF. These data demonstrate that malnutrition is an independent predictor of survival in patients with liver cirrhosis. The inclusion of anthropomet ric measures in the assessment of these patients might provide better progn ostic information. (C) Elsevier Science Inc. 2001.