الفهرس 
Acknowledgements
Overview of MalnutritionOnly 14 pages are availabe for public view
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Abstract
Summary and Conclusion
Malnutrition is being well understood and appreciated as an important factor in the management of cirrhotic patients. Identifying the patients who are approaching the state of malnutrition by simple and easily applied methods is necessary in order to provide a nutritional support to those who need it the most. Anthropometric assessment, being easily done at bedside, may serve as an important tool in this process of identification.
It was a cross sectional single analytic type of study carried out on 101 patients which were selected randomly in Al- Rajhy Assiut University hospital. This study was conducted to assess the nutritional status of hospitalized cirrhotic patients to identify those who are malnourished and the relationship of the nutritional status with various stages of cirrhosis as determined by Child Pugh score, MELD and MELD Na scores.
The most common etiology of cirrhosis in our study was viral hepatitis, where HCV is the frequent prevalent among the studied population (94.1%).
The frequent associated clinical manifestations were: ascites (56.4%), jaundice (26.7%), and anemia (18.8%).
The studied patients were classified based on the frequently used prognostic scores; Child, MELD, and MELD Na:
Based on Chlid score classification; Child A (21.8%), Child B (52.5%), and Child C (25.7%).
The patients had variable severity of liver injury according to MELD and MELD Na scores which were ranged (6.0 – 29.0) and (6.0 – 48.0), respectively.
Various nutritional assessment tools were used to assess malnutrition in cirrhotic patients in this study including the anthropometric parameters (BMI, TSFT, MAC, MAMC), body composition analysis by using whole body foot to foot bioelectrical impedance analysis, subjective global assessment (SGA), creatinine height index (CHI), prognostic nutritional index (PNI) and controlling nutritional status (CONUT).
According to PNI and COUNT malnutrition was found in 98% in our patients and most of our patients (54.9 %) had severe malnutrition based on CONUT.
Based on CHI, protein energy malnutrition was detected in 94.1% while 64.4 % of the studied population were malnourished by SGA.
BMI described malnutrition in (25.7 %) of our patients, TSFT showed moderate and severe malnutrition to be present in 21.8% and 25.7% respectively. While malnutrition was found in 75.2% and in 67.3 % of the participants when assessed by MAC, MAMC.
According to body composition analysis 22.8 % of the studied patients had very low fat mass while 13.9 % had high water content.
There was no statistical significant difference in the anthropometeric parameters between groups of Child score except in MAC between Child A and B and between Child A and C and in MAMC between Child A and B.
Patients with severe malnutrition when assessed by BMI, TSFT, MAC, MAMC and fat percent had higher MELD and MELD Na scores (≥ 25).
There was no statistical significant difference in body composition analysis between groups of Child score except in water percentage between child A and B and between child A and C.
Class A of SGA was more prevalent in Child A however class B and C were more in Child C with significant difference between Child A and B, A and C However no significant variation in SGA classes between groups of MELD and MELD Na scores was seen.
The mean values of CHI and PNI were significantly decreased from Child A to C and from lower to higher scores of MELD and MELD Na. However, CONUT was significantly lower in Child A and in mild liver disease but was similar in Child B and C and in moderate and severe liver disease
There was a decline in values of BMI, TSFT, MAC, MAMC with the decrease in value of CHI. There was a decrease in value of BMI with the decrease in value of PNI. There was a difference in values of TSFT, MAC, MAMC among groups of PNI without decreasing in accordance with the change in PNI value.
The diagnostic accuracy of the SGA were low in comparison with other objective parameters (TSFT, MAC, CHI, PNI) where, the accuracy was varied from 64.4% to 76%
In conclusion Protein-calorie malnutrition is a common complication of liver cirrhosis in Egyptian patients. Nutritional disorders appeared to be related to the degree of liver injury and nutritional status is good in early stages of liver cirrhosis, and deteriorates in end stage liver disease.
The nutritional status of cirrhotic patients is an important tool, together with Child score and MELD score, for the prediction of prognosis of such patients, and the severity of malnutrition is associated with higher mortality. Early referral of cirrhotic patients with bad nutritional status for transplantation is recommended.
Clinical assessment by the anthropometric parameters demonstrated a trend towards more malnutrition with increasing clinical severity of liver disease, although this was not statistically significant.
CHI is a very good predictor of muscle mass and protein contents of the hepatic patients
The PNI and CONUT could have great potential for nutritional assessment in patients with chronic liver disease, and they could be standard assessment tools in ordinary medical care, because of their simplicity.
All the nutritional assessment tools are needed together with no substitution of one method by another for the precise assessment of malnutrition among cirrhotic patients.