Clinical assessment of malnutrition among patients with alcoholic liver cirrhosis: A single-center study in Southern China

Abstract

BACKGROUND

The burden of alcohol-related liver disease in China is becoming increasingly significant, and malnutrition in Chinese patients with alcoholic liver cirrhosis (ALC) is inadequately characterized.

AIM

To evaluate nutritional assessment tools, detail anthropometric and micronutrient alterations, and their associations with disease severity and prognosis in ALC.

METHODS

This case-control study included hospitalized male ALC patients, age-matched patients with hepatitis B virus-related cirrhosis (HBV-C), and relatively healthy controls (HCs). Nutritional status was assessed using subjective global assessment (SGA) and nutritional risk screening 2002 (NRS-2002) scores, anthropometric measurements, and serum levels of trace elements and vitamins. Kaplan-Meier analysis and Cox regression were employed to determine survival outcomes.

RESULTS

We enrolled 249 male ALC patients, 103 HBV-C patients, and 83 HCs. ALC patients demonstrated significantly lower hemoglobin, magnesium (Mg), vitamin D (VD), vitamin B (VB) 1, and VB2 levels than the HBV-C group (P < 0.001). Notably, ALC patients exhibited a unique nutritional phenotype: Increased central adiposity (higher waist circumference, hip circumference, and abdominal fat thickness) despite higher mid-arm circumference (AC) and arm muscle circumference values than HBV-C patients. Malnutrition progressed with disease severity; serum zinc (Zn), Mg, corrected calcium and VD were significantly lower in Child-Pugh B/C than in class A patients. Low albumin levels, Child-Pugh B/C, reduced AC, and high SGA/NRS-2002 scores were associated with decreased survival. Multivariate analysis identified low Zn [hazard ratio (HR) = 0.51], low VD (HR = 0.92), and reduced AC (HR = 0.85) as independent predictors of liver-related mortality.

CONCLUSION

ALC patients exhibit unique malnutrition phenotypes and micronutrient deficiencies. Low Zn, VD, and AC are independent prognostic predictors, necessitating etiology-specific nutritional interventions to improve clinical outcomes.

Keywords: Alcoholic liver cirrhosis; Malnutrition; Micronutrients; Body composition; Anthropometric evaluation; Nutritional assessment tools; Prognosis

Core Tip: This study identifies a unique malnutrition phenotype in Chinese male patients with alcoholic liver cirrhosis (ALC), featuring pronounced anemia, hypoproteinemia, and central adiposity despite relatively higher muscle circumferences. Severe zinc, magnesium, and vitamin D depletion correlates with disease severity. Notably, mid-arm circumference remains a robust bedside survival predictor despite the potential confounding effects of fluid retention. Furthermore, the independent prognostic value of serum zinc and vitamin D levels highlights their potential as therapeutic targets. These findings advocate for etiology-specific nutritional assessment and early intervention to optimize clinical outcomes in ALC.