Liver

16 - Association Between Malnutrition, Nutritional Assessment Tools, Disease-Severity and Health-Related Quality of Life in Cirrhosis

Monday, October 8
2:25 PM - 2:35 PM
Location: Terrace Ballroom 2-3 (level 400)

Category: Liver
Elaine Chiu, MD, RD1, Lorian Taylor, PhD, MPH, RD1, Louisa Lam, RD2, Kaleb Marr, BSc, MBBS, FRCPC1, Melanie Stapleton, MD, FRCPC1, Puneeta Tandon, MD, FRCP(C), MSc(Epi)3, Maitreyi Kothandaraman, MD, MSc, FRCPC1
1University of Calgary, Calgary, AB, Canada; 2Alberta Health Services, Calgary, AB, Canada; 3University of Alberta, Edmonton, AB, Canada

Introduction: In cirrhosis patients, identifying significant associations between malnutrition, disease-severity and health-related quality of life (HRQoL) may help identify important targets for clinical assessment.

Methods: The primary aim of this prospective study from 2014-2017 was to explore the influence of (1) nourishment state measured by subjective global assessment (SGA [Figure 1]), mid-arm circumference (MAC) and hand-grip strength (HGS), and; (2) disease-severity using Model of End-Stage Liver Disease score (MELD-Na) on HRQoL. HRQoL was measured with the validated Short-Form (SF) 36 subscales: vitality (V), physical function (PF), bodily pain (BP), general health (GH), physical role (PR), emotional role (ER), social function (SF) and mental health (MH).  After identifying correlations ≥ 2, variables were entered into regression analyses controlled for age and gender. If a curvilinear relationship was present the Kruskal-Wallis test was used. 

Results: This study included 81 patients with SGA breakdown outlined in Figure 2. After evaluation of correlation matrices, MELD-Na had correlation ≥ 2 with GH; MAC did not have any correlations ≥ 2 with any HRQoL subscale; HGS had correlations ≥ 2 with all subscales excluding SF, and; SGA had correlations ≥ 2 with all subscales. For SGA, PR demonstrated a significant relationship between SGA levels A and B compared to C (chi-squared=0.63, p=0.04);  PF worsened as SGA did (Adjusted R2=19%; β=-0.24, p=0.03); V and SF worsened as SGA did (Adjusted R2=8% for both;  β=-0.28, p=0.02 and β=-0.32, p<0.01), and; SGA had a borderline nonsignificant relationship with GH (β=-0.23, p=0.08).  HGS was only significantly associated with PF (β=0.36, p<0.01). MELD-Na and MAC did not demonstrate any significant relationships with HRQoL. Neither BP nor MH demonstrated any significant relationships with assessment tools.

Discussion: Malnutrition was present in 70% of the study patients and was significantly related to decreased HRQoL for 4 subscales including physical role, physical function, vitality, and social function. Malnutrition measured by SGA was the only significant relationship with HRQoL in most analyses; HGS was significantly related to physical function only. This study identifies SGA as an important clinical tool to measure in cirrhosis patients and moderate to severe malnutrition (SGA B or C) is associated with reduced HRQoL. Future studies should explore if improvements in SGA relate to improved HRQoL.

Figure 1. Subjective Global Assessment criteria to assess nutritional status
Figure 2. Breakdown of SGA of 81 patients

Disclosures:
Elaine Chiu indicated no relevant financial relationships.
Lorian Taylor indicated no relevant financial relationships.
Louisa Lam indicated no relevant financial relationships.
Kaleb Marr indicated no relevant financial relationships.
Melanie Stapleton indicated no relevant financial relationships.
Puneeta Tandon indicated no relevant financial relationships.
Maitreyi Kothandaraman indicated no relevant financial relationships.

Elaine Chiu

Resident
University of Calgary
Calgary, Alberta, Canada

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16 - Association Between Malnutrition, Nutritional Assessment Tools, Disease-Severity and Health-Related Quality of Life in Cirrhosis



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