Malnutrition negatively impacts the quality of life of patients with cirrhosis: An observational study

Table 1 Comparison between the patient characteristics according to the self-perception of quality of life

Characteristic	Good quality of life (n = 51)	Impairment of quality of life (n = 76)	P
Male	24 (47.1)	33 (43.4)	0.69
Age (yr)	54.8 ± 10.3	53.7 ± 13.5	0.61
Decompensated or Child B/C	30 (58.8)	63 (82.9)	0.003
Etiology
Alcohol	28 (55.0)	40 (52.7)	0.83
Viral	9 (17.6)	15 (19.7)
NASH	2 (3.9)	1 (1.3)
Cryptogenic	8 (15.7)	13 (17.1)
Autoimmune	4 (7.8)	7 (9.2)
Weight in kg	65.2 ± 14.9	63.7 ± 13.4	0.55
Body mass index (kg/m2)	26.6 ± 5.2	26.8 ± 4.0	0.32
Triceps skinfold thickness (cm)	1.4 ± 0.7	1.4 ± 0.8	0.79
Mid-arm circumference (cm)	26.4 ± 4.7	23.9 ± 3.7	0.001
Ideal mid-arm muscle circumference (cm)	22.1 ± 4.1	19.6 ± 2.8	< 0.0001
Malnourished according to SGA	14 (27.5)	55 (72.4)	< 0.0001
Presence of ascites	19 (37.3)	48 (63.2)	0.004
Need for paracentesis	7 (13.7)	25 (32.9)	0.02
Development of variceal bleeding	12 (23.5)	18 (23.7)	0.98
Development of hepatic encephalopathy	19 (37.3)	30 (39.5)	0.80
Bacterial infection requiring hospitalization	6 (11.8)	14 (18.4)	0.45
Any complication requiring hospitalization	32 (62.7)	62 (81.6)	0.02

Categorical variables are expressed as n (%), and compared by χ² or Fisher’s exact test. Numeric variables are expressed as median and SD, and compared by Student’s t-test. Statistical significance was considered as a P-value of < 0.05. NASH: Non-alcoholic steatohepatitis; SGA: Subjective global assessment.

Table 2 Multivariate analysis to identify factors associated with self-perception of impairment of quality of life

Characteristic	HR (95%CI)	P
Malnourished according to SGA	2.8 (1.6-5.0)	< 0.0001
Need for paracentesis	1.8 (1.0-3.2)	0.05
Presence of ascites	1.4 (0.7-2.7)	0.38
Any complication requiring hospitalization	1.1 (0.5-2.6)	0.82
Decompensated or Child B/C	1.8 (0.0-4.0)	0.14

Cox regression, statistical significance was considered as a P-value of < 0.05. HR: Hazard ratio; SGA: Subjective global assessment.

Table 3 Chronic Liver Diseases Questionnaire items comparison according to nutritional status

CLDQ item	Well-nourished (n = 58)	Malnourished (n = 69)	P
1 How much of the time during the last 2 wk have you been troubled by a feeling of abdominal bloating?	5.72 ± 1.531	4.67 ± 2.056	0.001
2 How much of the time have you been tired or fatigued during the last 2 wk?	3.69 ± 1.366	2.94 ± 1.259	0.002
3 How much of the time during the last 2 wk have you experienced body pain?	4.14 ± 0.868	3.57 ± 0.848	0.0001
4 How often during the last 2 wk have you felt sleepy during the day?	5.05 ± 1.343	4.55 ± 1.105	0.02
5 How much of the time during the last 2 wk have you experienced abdominal pain?	5.45 ± 1.273	4.96 ± 1.529	0.05
6 How much of the time during the last 2 wk have you experienced dyspnea on exertion, being a problem for you in your daily activities?	6.16 ± 0.951	5.33 ± 1.431	0.0001
7 How much of the time during the last 2 wk have you not been able to eat as much as you would like?	6.12 ± 1.010	3.55 ± 1.549	0.0001
8 How much of the time in the last 2 wk have you been bothered by having decreased strength?	4.91 ± 1.218	2.90 ± 1.447	0.0001
9 How often during the last 2 wk have you had trouble lifting or carrying heavy objects?	5.62 ± 0.834	4.09 ± 1.391	0.0001
10 How often during the last 2 wk have you felt anxious?	5.52 ± 1.112	5.33 ± 1.379	0.41
11 How often during the last 2 wk have you felt a decreased level of energy?	5.19 +1.100	3.20 ± 1.491	0.0001
12 How much of the time during the last 2 wk have you felt unhappy?	5.12 ± 1.077	4.41 ± 1.527	0.003
13 How often during the last 2 wk have you felt drowsy?	4.97 ± 1.324	4.55 ± 1.051	0.05
14 How much of the time during the last 2 wk have you been bothered by a limitation of your diet?	4.14 ± 1.206	3.91 ± 1.160	0.29
15 How often during the last 2 wk have you been irritable?	5.52 ± 1.128	5.36 ± 1.175	0.45
16 How much of the time during the last 2 wk have you had difficulty sleeping at night?	5.02 ± 1.493	4.87 ± 1.444	0.57
17 How much of the time during the last 2 wk have you been troubled by a feeling of abdominal discomfort?	5.62 ± 1.437	4.77 ± 1.816	0.004
18 How much of the time during the last 2 wk have you been worried about the impact your liver disease has on your family?	5.84 ± 1.056	5.94 ± 1.371	0.66
19 How much of the time during the last 2 wk have you had mood swings?	5.50 ± 1.417	5.83 ± 1.283	0.18
20 How much of the time during the last 2 wk have you been unable to fall asleep at night?	5.10 ± 1.360	4.67 ± 1.569	0.99
21 How often during the last 2 wk have you had muscle cramps?	5.52 ± 1.047	5.39 ± 1.074	0.51
22 How much of the time during the last 2 wk have you been worried that your symptoms will develop into major problems?	4.19 + 1.515	4.45 ± 1.586	0.35
23 How much of the time during the last 2 wk have you had a dry mouth?	5.40 ± 1.184	5.30 ± 1.192	0.66
24 How much of the time during the last 2 wk have you felt depressed?	5.33 ± 1.082	4.68 ± 1.745	0.01
25 How much of the time during the last 2 wk have you been worried about your condition getting worse?	4.05 ± 1.191	4.28 ± 1.454	0.34
26 How much of the time during the last 2 wk have you had problems concentrating?	5.34 ± 1.132	4.74 ± 1.569	0.01
27 How much of the time have you been troubled by itching during the last 2 wk?	5.71 ± 1.451	6.20 ± 1.065	0.03
28 How much of the time during the last 2 wk have you been worried about never feeling any better?	4.07 ± 1.153	4.36 ± 1.382	0.20
29 How much of the time during the last 2 wk have you been concerned about the availability of a liver if you need a liver transplant?	4.22 ± 1.312	4.23 ± 1.467	0.97

Data are expressed as median and SD, and compared with Student’s t-test. Statistical significance was considered as a P-value of < 0.05. CLDQ: Chronic Liver Diseases Questionnaire.