“Assessment of Protein Energy Malnutrition in Cirrhosis and Comparing Severity of Pem with Prognosis of Cirrhosis”

Abstract

Background: Cirrhosis is a progressive liver disease linked to substantial morbidity and mortality, with protein-energy malnutrition (PEM) being a common yet often overlooked complication. PEM significantly worsens patient outcomes by increasing susceptibility to complications and negatively impacting prognosis. Despite its high prevalence, the relationship between PEM severity and cirrhosis prognosis remains insufficiently explored, especially within specific local populations. Early identification and nutritional intervention may play a critical role in improving patient outcomes.

Aim: To assess the prevalence of protein-energy malnutrition in patients with cirrhosis and to evaluate the association between the severity of PEM and the prognosis of cirrhosis.

Materials and Methods: This cross-sectional study was conducted at Aarupadai Veedu Medical College and Hospital over 18 months, involving 80 patients diagnosed with cirrhosis. Nutritional status was assessed using Subjective Global Assessment (SGA), and cirrhosis severity was classified using the Child-Turcotte-Pugh (CTP) score. Anthropometric measurements, biochemical parameters, and handgrip strength were evaluated. The association between PEM severity and cirrhosis prognosis was analyzed using chi-square and ANOVA tests, with statistical significance set at p < 0.05.

Results: The study population had a mean age of 49.82 years, with 96.3% male predominance. Alcohol consumption was observed in 92.5% of patients. Based on CTP classification, 50.0% were in Class C, 33.8% in Class B, and 16.3% in Class A. SGA assessment showed 50.0% were well-nourished, 42.5% moderately malnourished, and 7.5% severely malnourished. A significant association was found between CTP classification and SGA scores (Chi-square = 21.62, p = 0.01), demonstrating that worsening liver function correlates with severe malnutrition. The highest mean CTP score (11.5 ± 1.9) was observed in SGA Class C, indicating a strong link between malnutrition and advanced cirrhosis.

Conclusion: The study highlights a significant correlation between worsening liver function and increasing severity of PEM in cirrhosis. These findings emphasize the importance of early nutritional assessment and targeted interventions to improve patient prognosis. A multidisciplinary approach integrating hepatology and nutrition is crucial for optimal disease management. Further research with larger sample sizes and objective nutritional markers is needed to develop standardized nutritional guidelines for cirrhotic patients.