Visceral Adiposity Associates With Malnutrition Risk Determined by Royal Free Hospital-Nutritional Prioritizing Tool in Cirrhosis.

Xiaoyu Wang,Bangmao Wang,Yifan Li,Jie Zhang,Chaoqun Li,Wanting Yang,Xiaofei Fan,Chao Sun,Gaoyue Guo,Kui Jiang,Xingliang Zhao,Mingyu Sun,Yangyang Hui,Zihan Yu

doi:10.3389/fnut.2021.766350

Abstract

Mounting evidence has suggested the clinical significance of body composition abnormalities in the context of cirrhosis. Herein, we aimed to investigate the association between visceral adiposity and malnutrition risk in 176 hospitalized patients with cirrhosis. The adiposity parameters were obtained by computed tomography (CT) as follows: total adipose tissue index (TATI), visceral adipose tissue index (VATI), subcutaneous adipose tissue index (SATI), and visceral to subcutaneous adipose tissue area ratio (VSR). Malnutrition risk was screened using Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT). Visceral adiposity was determined given a higher VSR based on our previously established cutoffs. Multivariate analysis implicated that male gender (OR = 2.884, 95% CI: 1.360–6.115, p = 0.006), BMI (OR = 0.879, 95% CI: 0.812–0.951, P = 0.001), albumin (OR = 0.934, 95% CI: 0.882–0.989, P = 0.019), and visceral adiposity (OR = 3.413, 95% CI: 1.344–8.670, P = 0.010) were independent risk factors of malnutrition risk. No significant difference was observed regarding TATI, SATI, and VATI among patients with low or moderate and high risk of malnutrition. In contrast, the proportion of male patients embracing visceral adiposity was higher in high malnutrition risk group compared with that in low or moderate group (47.27 vs. 17.86%, p = 0.009). Moreover, this disparity was of borderline statistical significance in women (19.05 vs. 5.88%, p = 0.061). Assessing adipose tissue distribution might potentiate the estimation of malnutrition risk in cirrhotics. It is pivotal to recognize visceral adiposity and develop targeted therapeutic strategies.

Highlights

Malnutrition is prevalent in patients with cirrhosis, which contributes to the increased risk of morbidity and mortality [1]
The etiology of cirrhosis was attributed to chronic hepatitis B virus (HBV) or hepatitis C virus (HCV) infection in 45 (25.57%), alcohol in 45 (25.57%), autoimmune liver disease in 41 (23.29%), and nonalcoholic fatty liver disease (NAFLD) and cryptogenic reasons in 45 (25.57%) subjects, respectively
The median MELD-Na score upon hospitalization was 10 (IQR, 6–13.75). These patients were divided into two groups in terms of malnutrition risk determined by Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) score

Summary

Introduction

Malnutrition is prevalent in patients with cirrhosis, which contributes to the increased risk of morbidity and mortality [1]. It is of utmost importance to identify malnourished subjects and institute nutritional therapy with the purpose of reducing mortality, systemic inflammatory response, and infection [2, 3]. The Royal Free Hospital-Nutritional Prioritizing Tool (RFHNPT) is a cirrhosis-specific nutrition screening tool. In an established and validated cohort of 148 patients with chronic liver disease, the RFH-NPT represented a useful predictor of clinical deterioration and poor outcome [4]. Our previous work implicated that malnutrition risk estimated by RFH-NPT is dramatically associated with distorting immune function in the context of cirrhosis [5]

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