الفهرس 
-Introduction
Liver anatomy and physiologyOnly 14 pages are availabe for public view
 |  | from | 125 |  |  |
| | | from | 125 | | |
Abstract
Patients with chronic liver disease develop malnutrition since liver plays key role in carbohydrate, protein, lipid, vitamin and mineral metabolism. It is also the largest and most complex organ in the body and plays an essential role in many body functions. Malnutrition is an increasing recognized complication of chronic liver disease and has important prognostic implications. Malnourished patients with chronic liver disease have a higher rate of complications and overall, an increased mortality.
Due to high prevalence and increased complications resulting from malnutrition, it is important to assess the nutritional status and initiate timely intervention in patients suffering from chronic liver disease.
The aims of our study were to asses nutritional status of hospitalized cirrhotic patients in El-Rajhi Liver Hospital and to compare different methods used for assessment of nutritional status of hospitalized cirrhotic patients in El-Rajhi Hospital.
The present study was hospital based cross sectional study. It was carried out in El-Rajhi Hospital in Assiut University. It included all eligible patients admitted to El-Rajhi Hospital from November 2014 to April 2015 (six months), the study included one hundred and three patients who fulfilled the predetermined inclusion criteria. Patients with hepatocellular carcinoma, renal impairment, severe hepatic encephalopathy and younger patients <18 years were excluded from the study.
Overall mean age was 52.14± 10.007 years with a range from 19 to 83 years. Data were collected by structured questionnaire which was filled by the researcher herself. These data included personal data, data related to medical history regarding aetiology of liver cirrhosis, Child-Pugh scoring for severity of liver cirrhosis and presence of major complications.
24-hr urine was collected from ninety three patients only to calculate the creatinine height index and anthropometric measurements (BMI, MAC, TSFT and MAMC) were measured for every patient and the patients were classified according to Subjective Global Assessment score (SGA).
Serum albumin was measured for the patients as a tool for nutritional assessment and body compositions were measured for every patient as regard body percentages of fat, water, muscle and bone.
The most common aetiology of liver cirrhosis was post viral C infection (60.2 %) and the majority of cases (64.1%) were classified as Child-Pugh score C. The most common complication of liver cirrhosis was tense ascities and spontaneous bacterial peritonitis.
According to Creatinine Height Index, malnutrition was present in 89.2% of the patients, 11 patients of them (11.8%) were mildly malnourished, 38 patients (40.8%) were moderately malnourished and 35 patients (36.6%) were severely malnourished and the mean value of CHI was 49.4% and CHI differed significantly between the Child A, B and C groups (P value= 0.000).The mean value of serum albumin was 2.3±0.53 g/dl, there is statistical significant difference between means of serum albumin and Child score A, B and C.
According to anthropometric measurements, mean value of MAC and TSFT and MAMC was 22.8 cm, 9.6 mm and 20.6 cm respectively. Malnutrition was present in 87.4% of patients by MAC and by MAMC, 86.4% of patients were malnourished by TSFT. The mean values of anthropometric measurements showed significant deterioration in these parameters with disease progression from Child-Pugh class A to class C. As expected, mean values of anthropometric measurements such as MAC, TST and MAMC demonstrated significant differences in values between cirrhotic patients in SGA grades A, B and C, with a higher SGA grade correlating well with lower anthropometric values (P-value=0.000).
According to SGA, malnutrition was present in 92.2% of the patients, 43 patients of them (41.7%) were moderately malnourished and 52 of them (50.5%) were severely malnourished. There is no significant statistical difference between sex and SGA score and also there is statistical significant difference between malnutrition assessed by SGA in the studied patients and the number of their children, where percentage of malnutrition increased with the increase of number of their children.
There were higher proportion of patients with SGA grade C in Child-Pugh C cirrhotic compared to Child-Pugh B cirrhotic patients, and this indicates worsening of SGA status in the late stage of the disease and this is statistically significant.
There is statistical significant difference between means of water, fat, muscle and bone percentages and Child score A, B and C. The mean values showed significant deterioration in these parameters with disease progression from Child-Pugh class A to class C except water percentage which increases from Child A to C.
We recommend that all cirrhotic patients should undergo baseline nutritional assessment as part of management planning; assessments should be repeated at regular intervals or as indicated by clinical condition