Cirrhotic patients often suffer from malnutrition due to decrease in nutrient consumption or impaired liver metabolism [
Twenty-two patients who were diagnosed of having liver cirrhosis based on clinical and histological evidences, or imaging diagnosis, were recruited from Ramathibodi Hospital, Bangkok, Thailand. Clinical evidence of cirrhosis was defined with the presence of portal hypertension and hepatic insufficiency [
The study was a cross-sectional, prospective clinical trial. Each patient, among all 22 patients who visited the nutrition clinic, received 20 grams of vegetable protein (soy) supplementation per day add on their regular diet for 8 weeks. The detail nutritional composition of the supplements used in this study is shown in Table
Nutritional content per pack of supplement.
Vegetable protein (soy) supplementation | |
---|---|
Energy (Kcal) | 420 |
Protein (g) | 20 |
Carbohydrate (g) | 65 |
Fat (g) | 10.6 |
Calcium (mg) | 190 |
Sodium (meq) | 72 |
Potassium (meq) | 2400 |
Nutritional assessment was based on the following: anthropometry, bioelectrical impedance, visceral protein, and subjective global assessment (SGA). All measurements were taken by the same investigator to avoid any interobserver variation at baseline, the 4th week and the 8th week.
Body weight was measured by Soehnle 7755, a digital weighing scale (Soehnle Professional, Backnang, Germany). Triceps skinfold thickness (TST) was measured by Harpenden skinfold caliper (Inter Reha, Tokyo, Japan).
Body composition was measured in the morning after an overnight fast. Body composition was determined with the use of InBody 720 body composition analyzer (Biospace Corporation, Seoul, Republic of Korea). Body mass was recorded to the nearest value of 100 grams on calibrated digital scale.
Serum albumin and prealbumin are frequently used laboratory parameters to measure nutritional status. In spite of their nonspecificity, they have been used to assess the change in nutritional status and stratifying risk of malnutrition [
subjective global assessment (SGA) is a simple evaluative tool that allows a physician to assess the patient’s nutritional status [
Assessment of individual patient’s oral intake was determined by the 3-day dietary recall method at baseline, the 4th week and the 8th week.
Baseline characteristics, blood chemistry test results, and body compositions of all subjects were reported by using mean ± standard deviation (SD). SGA was reported by frequency. Statistical analysis was conducted using SPSS software version 13.0 for windows. Means were compared by Wilcoxon signed-rank test and frequencies were compared by corrected chi-square test.
The characterization of the study population is presented in Table
Characterization of the study population.
Variables | All patients |
---|---|
Sex (male/female) | 12/10 |
Age (years) | 52.9 ± 12.8 |
Child-Pugh— |
|
A | 14 (63.6%) |
B | 5 (22.7%) |
C | 3 (13.6%) |
Etiology— |
|
Alcohol | 14 (63.6%) |
Virus B | 6 (27.3%) |
Virus C | 2 (9.0%) |
Caloric intake (kcal/kg/day) | 25.1 ± 5.6 |
Protein intake (g/kg/day) | 1.1 ± 0.6 |
After vegetable protein supplementation, a significant improvement was demonstrated in the SGA class A from 10 patients (45.5%) to 16 (72.7%) and 18 (81.8%) at the 4th and 8th weeks, respectively (See Table
Nutritional parameters in patients with cirrhosis at baseline and after vegetable protein supplementation†.
Variables | Baseline | 4th week | 8th week |
---|---|---|---|
Body weight (kg) | 54.7 ± 1.9 | 55.4 ± 1.8 | 56.1 ± 1.8* |
Body mass index (kg/m2) | 21.4 ± 0.6 | 21.6 ± 0.7 | 21.9 ± 0.7* |
Lean muscle mass (kg) | 41.2 ± 3.3 | 41.7 ± 2.9 | 42.4 ± 2.7* |
Fat mass (kg) | 13.6 ± 0.9 | 13.5 ± 1.7 | 13.5 ± 1.4 |
Total body water (kg) | 30.1 ± 2.2 | 30.5 ± 2.1 | 30.8 ± 1.9 |
Triceps skinfold thickness (mm) | 10.9 ± 4.2 | 11.3 ± 3.5 | 11.4 ± 3.8 |
Albumin (g/dL) | 3.8 ± 0.3 | 3.9 ± 0.2 | 3.9 ± 0.2 |
Prealbumin (g/dL) | 1.4 ± 0.3 | 1.5 ± 0.3 | 1.5 ± 0.3 |
Subjective global assessment— |
|||
A | 10 (45.5%) | 16 (72.7%)** | 18 (81.8%)** |
B | 11 (50.0%) | 5 (22.7%)** | 4 (18.1%)** |
C | 1 (4.5%) | 1 (4.5%) | 0 (0%) |
†Data are presented as mean ± SD.
*
**
Nutritional assessment is of crucial importance in the management of patients with liver cirrhosis. Malnutrition is common in liver cirrhosis and has an adverse effect on prognosis [
Malnutrition has been found to be as common as 80% [
Clinical assessment with the SGA in the form of single score and lean muscle mass are significant parameters to evaluate nutritional improvement in patients with cirrhosis after vegetative protein supplementation.
The authors declare that they have no conflict of interests.
The authors wish to thank the study participants for taking part in this study and all of the colleagues who contributed to the study.