Nutrition status and its impact on quality of life and performance status in end-stage liver disease

Aim: Malnutrition in end-stage liver disease (ESLD) patients has been associated with various prognostic factors. However, its effect on nonconventional parameters is least studied. The present exploratory study analyzes the impact of malnutrition on quality of life (QoL) and performance status (PS) in ESLD. Methods: We recruited 54 adult ESLD patients. Nutrition status assessment was performed by different validated tools such as subjective global assessment (SGA), mid-upper arm circumference, triceps skinfold measurements, mid-arm muscle circumference, and body mass index (BMI) for ascites. QoL and PS were assessed by Short Form-36 Interview and Eastern Cooperative Oncology Group-PS, respectively. Results: Malnutrition in patients ranged from 24.1% to 88.9% by various nutrition assessment techniques. ESLD patients showed lower levels of QoL and PS. SGA showed that malnourished patients had significantly lower PS grades than normal patients (P < 0.05). The Chi-square adjusted Z-scores showed that moderately malnourished patients had significantly higher PS-Grade-3 (capable of only limited self-care); further, severely malnourished patients had significantly higher PS-Grade-4 (completely disabled) (P < 0.004). Furthermore, malnutrition also showed lower QoL scores. After Bonferroni correction, SGA showed significantly lower emotional well-being scores of QoL in severely malnourished patients. BMI for ascites also showed significantly lower physical functioning and physical component summary scores of QoL among severely malnourished patients. Albumin level showed a significant positive correlation with emotional well-being of the patients.Conclusion: Hence, higher degree malnutrition among ESLD is associated with lower QoL and PS. The data addresses the need for planning nutrition interventions to ameliorate malnutrition in ESLD patients to improve QoL and PS for better prognosis