Impact of Intensive Dietary Counseling on  Serum Albumin in Haemodialysis Patients with Chronic Liver Disease

People on maintenance haemodialysis (MHD) are at risk of developing malnutrition, which is defined as the consequence of insufficient food intake or a suboptimal quality diet. The kidney and the liver play a central role in protein metabolism. The major aim of the study was to evaluate, for the first time in Romania, the impact of intensive dietary counseling and personalised diets on serum albumin (SA) and others nutritional parameters, but also the relationship between albumin level, inflammation and nutritional status in a cohort of haemodialysis patients which associate or not chronic liver disease (CLD). We prospectively analysed the inflammatory status and malnutrition in 162 HD patients, mean age 56�13 years, from a single dialysis centre. At baseline we evaluated: a. calorie-protein intake using patient�s diet history with the help of 72 hrs recall method;b. nutritional status by anthropometric measures- post dialysis body weight (BW), body mass index (BMI), TSF (tricipital skinfold), MAC (mid-arm circumference), MAMC (mid-arm muscle circumference);c. modified subjective global assessment score (mSGA);d. biochemical tests: pre-dialysis serum albumin, serum creatinine, alkaline reserve, Kt/V and Protein C Reactive (CRP). The patients were followed-up for 6 months.

Download Full-text

The association between serum albumin and depression in chronic liver disease may differ by liver histology

BMC Psychiatry ◽

10.1186/s12888-021-03647-8 ◽

2022 ◽

Vol 22 (1) ◽

Author(s):

Junyan Cao ◽

Weihong Qiu ◽

Yong Yu ◽

Na Li ◽

Huixiang Wu ◽

...

Keyword(s):

Depressive Symptoms ◽

Liver Disease ◽

Serum Albumin ◽

Chronic Liver Disease ◽

The United States ◽

Chronic Liver ◽

Liver Histology ◽

Depression Symptoms ◽

Inverse Association ◽

The Impact

Abstract Background There are conflicting results regarding the association between chronic liver disease (CLD) and depression and the underlying biological mechanisms are lack of investigation. To address the impact of depression and its effects on the management of CLD, its biological marker is critical to be identified. The present study explored the association between serum albumin and depression in CLD patients and whether the association varied in different liver histological stages. Methods Based on the United States National Health and Nutrition Examination Survey 2017–2018, the data of serum albumin and depressive symptoms from 627 participants with CLD were used. Depression symptoms were assessed with the nine-item Patient Health Questionnaire (PHQ-9). We used multivariate linear regression to evaluate the association between serum albumin and PHQ-9 scores. Stratified analysis was performed according to the liver histology examined by vibration controlled transient elastography. Results Serum albumin level was inversely associated with PHQ-9 scores in the multivariate regression model after adjusting for mainly potential confounders (β = − 1.113, 95% CI: − 2.065 to − 0.162, P = 0.0221). In the subgroup analysis stratified by gender, controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), the inverse association remained significant in female (β = − 2.002, 95% CI: − 3.515 to − 0.489, P = 0.0100), patients with CAP < 274 dB/m (β = − 2.215, 95% CI: − 3.621 to − 0.808, P = 0.0023) and patients with LSM ≥8.2 kPa (β = − 4.074, 95% CI: − 6.237 to − 1.911, P = 0.0003). Moreover, the association was much stronger when the serum albumin was higher than 3.4 g/dL among patients with LSM ≥8.2 kPa (β = − 4.835, 95% CI: − 7.137 to − 2.533, P < 0.0001). Conclusion Our study revealed an inverse association between serum albumin and depression in CLD patients and this association differed according to liver histological changes. Serum albumin could be a warning marker for depressive symptoms in CLD patients. It is essential for taking corresponding intervention strategies.

Download Full-text

Possible unrecognised liver injury is associated with mortality in critically ill COVID-19 patients

Therapeutic Advances in Gastroenterology ◽

10.1177/17562848211023410 ◽

2021 ◽

Vol 14 ◽

pp. 175628482110234

Author(s):

Mario Romero-Cristóbal ◽

Ana Clemente-Sánchez ◽

Patricia Piñeiro ◽

Jamil Cedeño ◽

Laura Rayón ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Liver Injury ◽

Chronic Liver Disease ◽

Critically Ill ◽

Cox Regression ◽

Chronic Liver ◽

Cox Regression Analysis ◽

Risk Of Death ◽

The Impact

Background: Coronavirus disease (COVID-19) with acute respiratory distress syndrome is a life-threatening condition. A previous diagnosis of chronic liver disease is associated with poorer outcomes. Nevertheless, the impact of silent liver injury has not been investigated. We aimed to explore the association of pre-admission liver fibrosis indices with the prognosis of critically ill COVID-19 patients. Methods: The work presented was an observational study in 214 patients with COVID-19 consecutively admitted to the intensive care unit (ICU). Pre-admission liver fibrosis indices were calculated. In-hospital mortality and predictive factors were explored with Kaplan–Meier and Cox regression analysis. Results: The mean age was 59.58 (13.79) years; 16 patients (7.48%) had previously recognised chronic liver disease. Up to 78.84% of patients according to Forns, and 45.76% according to FIB-4, had more than minimal fibrosis. Fibrosis indices were higher in non-survivors [Forns: 6.04 (1.42) versus 4.99 (1.58), p < 0.001; FIB-4: 1.77 (1.17) versus 1.41 (0.91), p = 0.020)], but no differences were found in liver biochemistry parameters. Patients with any degree of fibrosis either by Forns or FIB-4 had a higher mortality, which increased according to the severity of fibrosis ( p < 0.05 for both indexes). Both Forns [HR 1.41 (1.11–1.81); p = 0.006] and FIB-4 [HR 1.31 (0.99–1.72); p = 0.051] were independently related to survival after adjusting for the Charlson comorbidity index, APACHE II, and ferritin. Conclusion: Unrecognised liver fibrosis, assessed by serological tests prior to admission, is independently associated with a higher risk of death in patients with severe COVID-19 admitted to the ICU.

Download Full-text

Health-related quality of life in chronic liver disease: the impact of type and severity of disease

The American Journal of Gastroenterology ◽

10.1111/j.1572-0241.2001.03956.x ◽

2001 ◽

Vol 96 (7) ◽

pp. 2199-2205 ◽

Cited By ~ 184

Author(s):

Zobair M Younossi ◽

Navdeep Boparai ◽

Lori Lyn Price ◽

Michelle L Kiwi ◽

Marilyn McCormick ◽

...

Keyword(s):

Quality Of Life ◽

Liver Disease ◽

Chronic Liver Disease ◽

Chronic Liver ◽

Health Related Quality ◽

Severity Of Disease ◽

Related Quality ◽

Health Related ◽

The Impact

Download Full-text

NUTRITIONAL STATUS IN NONALCOHOLIC CHRONIC LIVER DISEASE

Nutrition Reviews ◽

10.1111/j.1753-4887.1976.tb05766.x ◽

2009 ◽

Vol 34 (7) ◽

pp. 207-208

Keyword(s):

Liver Disease ◽

Nutritional Status ◽

Chronic Liver Disease ◽

Chronic Liver

Download Full-text

Correlation Between Body Composition Analysis and Biochemical Nutritional Markers in Maintenance Hemodialysis Patients with Chronic Liver Disease

Revista de Chimie ◽

10.37358/rc.20.11.8378 ◽

2020 ◽

Vol 71 (11) ◽

pp. 94-100

Author(s):

Luciana Carmen Nitoi ◽

Valeriu Ardeleanu ◽

Anca Pantea Stoian ◽

Lavinia Alexandra Moroianu

Keyword(s):

Body Composition ◽

Liver Disease ◽

Nutritional Status ◽

Chronic Liver Disease ◽

The Body ◽

Chronic Liver ◽

Composition Analysis ◽

Arterial Line ◽

Body Protein ◽

Total Body

Several approaches have been used to assess protein-energy wasting syndrome, such as clinical evaluation, biochemical nutritional markers, anthropometric measurements, but Bioelectrical Impedance Analysis (BIA) techniques hold a central place in clinical settings. The aim of this study is to report our clinical experience with BIA and the correlations between biochemical nutritional markers and BIA nutritional parameters in hemodialysis (HD) patients associating or free of chronic liver disease. This cross-sectional observational study included 69 HD patients divided into two groups: 33 with chronic liver disease (CLD+) versus 36 chronic liver disease-free (CLD-) from one HD unit in Romania. Serum albumin (SA), serum creatinine (SCr) and C-reactive protein (CRP) were obtained from the HD arterial line immediately before the HD session and by BIA the body composition including total body water (TBW), total body fat (TBF), lean fat free mass(LFFM), body muscular mass (BMM), malnutrition index and body protein reserve (PR) were assessed. No significant differences between groups were found in BCM, BMM, PR and TBF (p = 0.92, p = 0.60, p = 0.907, and p = 0.634, respectively). Malnutrition index had a significantly higher mean value in HD-CLD(+) patients (p = 0.00). HD-CLD(-) group showed a strong correlation between SA and SCr and BCM, BMM (kg), LFFM (kg) and body PR (kg) (r=.48, r=.50, r=.44, r=.50; resp. r=.42, r=.40, r=.36, r=.42). In HD-CLD(+) patients, a significant positive correlation was found between SA and SCr and LFFM and body PR (r=.37, r=.35; resp. r=.44, r=.35). Discussion: BIA is one of the most accurate techniques for assessing nutritional status and should be regularly used in clinical practice along with biochemical nutritional markers in HD patients. Although the protein metabolism depends to a large extent on liver function, CLD cannot be considered as having a significant impact on nutritional status in HD patients.

Download Full-text

Impact of Severity of Chronic Liver Disease on Health-Related Economics

Hepatitis Monthly ◽

10.5812/hepatmon.97933 ◽

2020 ◽

Vol 20 (6) ◽

Author(s):

Fakhar Ali Qazi Arisar ◽

Muhammad Kamran ◽

Ramlah Nadeem ◽

Wasim Jafri

Keyword(s):

Socioeconomic Status ◽

Liver Disease ◽

Chronic Liver Disease ◽

Economic Status ◽

Treatment Compliance ◽

Chronic Liver ◽

Medical Expenses ◽

Severity Of Disease ◽

The Family ◽

The Impact

Background: Chronic liver disease (CLD) is one of the leading causes of morbidity and mortality worldwide. It is accountable for a multifaceted disease encumbrance upsetting the psychological, physical, and economic health of not only the patients but also their caregivers. Objectives: The study purposes to cover the economic aspect of CLD to comprehend the financial burden imposed on the patients. Methods: This cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. The CLD patients presenting in gastroenterology clinics were recruited, and their socio-demographic, financial, and disease-related information including Model for End-stage Liver Disease (MELD) score and Child Turcotte Pugh (CTP) scores were collected. Out of 190 CLD patients enrolled, 127 (67.2%) were males. The mean age was 50.09 years. Variables assessed include self-perceived social/economic status, self-perception of disease responsibility for worsening of social/economic situation, the impact of the disease on economic status due to medical expense, the impact of economic status on treatment compliance due to medical expenses, impact of severity of disease on socioeconomic status and treatment compliance, and impact of gender on disease status and treatment compliance. Results: Regardless of the disease duration, CLD significantly impacted a patient’s life, as 81% and 69% of the patients blamed their disease responsible for the worsening of social and economic conditions, respectively. In our study, 85% of patients had consumed all savings during their course of illness, and 67% had to borrow money for medical expenses. Nearly half of the patients had to leave or cut short their medicines, skip the physician's appointment, or defer their children's education. One-third of patients had unpaid medical and utility bills or even skipped their meals. The severity of disease affected the socioeconomic status significantly (89% in CTP class C vs. 40% in CTP class A). Patients with worsening socioeconomic status had significantly higher MELD scores as compared to those with stable socioeconomic status. Conclusions: Chronic liver disease imposes incredible socioeconomic encumbrance on patients and the family unit, and CLD associated expenditures influence the family unit’s everyday working and therapeutic compliance, which is directly linked to the severity of disease expressed in terms of CTP and MELD scores.

Download Full-text

Liver Fibrosis is Associated with a Decrease in Gait Speed in Older Men with Chronic Liver Disease: A Retrospective Cross-Sectional Study

10.21203/rs.3.rs-819599/v1 ◽

2021 ◽

Author(s):

Kenichi Fudeyasu ◽

Takuo Nomura ◽

Toshihiro Kawae ◽

Daisuke Iwaki ◽

Yuki Nakashima ◽

...

Keyword(s):

Liver Disease ◽

Liver Fibrosis ◽

Chronic Liver Disease ◽

Motor Function ◽

Gait Speed ◽

Older Patients ◽

Knee Extension ◽

Chronic Liver ◽

Cross Sectional ◽

The Impact

Abstract Background: Although it has already been reported that chronic liver disease (CLD) can induce sarcopenia, the impact of sarcopenia, especially on motor function, in older patients with CLD is still unclear. Therefore, we investigated the effects of liver fibrosis on motor function in these patients.Methods: In all, 117 older patients with CLD aged above 60 years (men, n=70; women, n=47) were included in this study. We examined the presence or absence of sarcopenia and checked motor functions such as muscle strength and walking speed. The results were compared between patients with FIB-4 index of >3.25, indicative of severe-degree liver fibrosis (SLF), and those with an index of <3.25, indicative of low-degree liver fibrosis (LLF). We also analyzed the factors related to the decrease in gait speed.Results: The decrease in gait speed (<1.0 m/s) was significantly higher (P = 0.027) and the knee extension force (KEF) was significantly lower (P = 0.010) in men with SLF than in those with LLF. In this study, liver fibrosis (odds ratio [OR] = 0.71, 95% confidence interval [CI] = 0.56–0.90) and KEF (OR = 1.09, 95% CI = 1.02–1.16) were identified as factors associated with the decrease in gait speed.Conclusions: Older male patients with CLD have decreased motor function as the disease progresses. We found that the decrease in gait speed is related to liver fibrosis and KEF. It is necessary to focus on the motor function of older patients with CLD, especially the gait speed.

Download Full-text

Comparing the effects of whey and casein supplementation on nutritional status and immune parameters in patients with chronic liver disease: a randomised double-blind controlled trial

British Journal Of Nutrition ◽

10.1017/s0007114520003219 ◽

2020 ◽

pp. 1-12

Author(s):

Y. G. G. Mizubuti ◽

E. L. M. Vieira ◽

T. A. Silva ◽

M. O. d’Alessandro ◽

S. V. Generoso ◽

...

Keyword(s):

Body Composition ◽

Liver Disease ◽

Nutritional Status ◽

Chronic Liver Disease ◽

Neurotrophic Factor ◽

Protein Intake ◽

Controlled Trial ◽

Protein Supplementation ◽

Chronic Liver ◽

Immune Parameters

Abstract Protein supplementation may be beneficial for patients with chronic liver disease (CLD). This study compared the effects of whey protein isolate (WP) and casein (CA) supplementation on nutritional status and immune parameters of CLD patients who were randomly assigned to take 20 g of WP or CA twice per d as a supplement for 15 d. Body composition, muscle functionality and plasmatic immunomarkers were assessed before and after supplementation. Patients were also classified according to the model for end-stage liver disease (MELD) into less (MELD < 15) and more (MELD ≥ 15) severe disease groups. Malnutrition, determined by the Subjective Global Assessment at baseline, was observed in 57·4 % and 54·2 % of patients in the WP and CA groups, respectively (P = 0·649). Protein intake was lower at baseline in the WP group than in the CA group (P = 0·035), with no difference after supplementation (P = 0·410). Both the WP and CA MELD < 15 groups increased protein intake after supplementation according to the intragroup analysis. No differences were observed in body composition, muscle functionality, most plasma cytokines (TNF, IL-6, IL-1β and interferon-γ), immunomodulatory proteins (sTNFR1, sTNFR2, brain-derived neurotrophic factor and glial cell line-derived neurotrophic factor) or immunomodulatory hormones (adiponectin, insulin and leptin) after supplementation in the WP groups at the two assessed moments. WP supplementation increased the levels of interferon-γ-induced protein-10/CXCL10 (P = 0·022), eotaxin-1/CCL11 (P = 0·031) and monocyte chemoattractant protein-1/CCL2 (P = 0·018) and decreased IL-5 (P = 0·027), including among those in the MELD ≥ 15 group, for whom IL-10 was also increased (P = 0·008). Thus, WP consumption by patients with CLD impacted the immunomodulatory responses when compared with CA with no impact on nutritional status.

Download Full-text