Malnutrition and liver disease in a developing country

Table 1 Effects of each micronutrient deficiency caused by liver disease

Micronutrient	Effect caused by deficiency in liver disease
Vitamin A	Dermatitis, night blindness, dyslipidemia, photophobia, increased risk of neoplasia
Vitamin B1	Wernicke encephalopathy and Korsakoff dementia
Vitamin B9	Dementia
Vitamin B12	Anemia, glossitis and neurological symptoms (numbness, muscle weakness and ataxia)
Vitamin D	Rare osteomalacia, increased risk of mortality
Vitamin E	Reduced antioxidation
Vitamin K	Increased risk of bleeding
Zinc	Hepatocyte dysfunction, increased risk of hepatic encephalopathy
Magnesium	Dysgeusia, increased risk of hepatic encephalopathy

Table 2 Nutritional assessment methods for chronic liver disease

Nutritional assessment methods	Description
Subjective global assessment (SGA)	Uses components of history and physical exam
Royal free hospital subjective global assessment (RFH-SGA)	Modified version of SGA, includes anthropometry and gender
Sarcopenia assessment
Computed tomography scan	Used to calculate skeletal muscle area and the skeletal muscle index at the L3 vertebral level
Anthropometry	Mid arm muscle circumference, skin fold thickness, BMI calculation
Dual-energy X-ray absorptiometry	A radiological modality that is used to measure bone mass, fat mass and fat free mass
Bioelectrical impedance analysis	Alternating current is used to estimate total body water, fat mass and fat free mass
Liver specific tools
Royal Free Hospital-Nutrition Prioritizing Tool	Includes weight loss, volume overload, BMI, and reduced oral intake, classifies patients according to risk of malnutrition
Liver Disease Undernutrition Screening Tool (LDUST)	The LDUST includes components of oral intake, weight loss, loss of subcutaneous fat or muscle mass, volume overload, and functional status
Dietary assessment	Includes dietary review, 3 d food diary, 24 h diet recall

BMI: Body mass index; SGA: Subjective global assessment.