الفهرس 
Background; chronic liver diseases and their effect on the metabolism and nutritionOnly 14 pages are availabe for public view
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Abstract
Malnutrition in chronic hepatic patients is very common and usually leads to high morbidity and mortality. Nutritional status of the patients should be evaluated starting with a nutritional screening which is followed by a full assessment of at risk patients. There are several assessment tools can be used in chronic hepatic patients. Commonly used nutritional assessment tools include functional measurements, anthropometric methods, biochemical measurements, subjective global assessment and dietary assessment.
Nutritional therapy should be based on the dietary recommendations to replace any deficiency related to energy, protein, lipids, carbohydrates, vitamins, and minerals. Dietary recommendations and guidelines for chronic hepatic patients were retrieved from the American Society of Parenteral and Enteral Nutrition (ASPEN) and European Society of Parenteral and Enteral Nutrition (ESPEN). Recommendation regarding energy requirements ranges from 25 to 40 kcal/ kg per day, while that regarding protein intake is 1.0-1.5 g/kg/day to avoid muscle wasting.
The aim of this work was to assess the nutritional status of patients with chronic liver disease in Ain Shams university hospital, to identify the relationship between hepatic disease severity and severity of malnutrition and to measure the degree of patient’s compliance with the current international nutritional guidelines.
An interview questionnaire was designed and applied on (161) chronic hepatic patients. The questionnaire includes dietary assessment, the PG-SGA and assessment of patient compliance to the current guidelines. Anthropometric assessment was carried out including weight, height, MAC and TSF. In addition, functional and biochemical assessment were carried out. chronic hepatic disease severity was assessed by using Child-Pugh classification.
In the current study, the majority of the patient suffered from hepatitis C infection (81.4%), followed by hepatitis B infection (8.1%). The majority of the studied chronic hepatic patients were males, illiterate, more than 45 years old
Study results revealed that the highest percent of the studied chronic hepatic patients were graded as Child A, followed by Child B, while only small percent were graded as Child C.
Regarding Patient-Generated Subjective Global Assessment (PG-SGA) and Royal Free Hospital-Subjective Global Assessment (RFH- SGA): more than half of the studied patients were moderately malnourished.
Regarding anthropometric assessment: By using BMI, more than one third of the studied patients were obese (36.7%). In addition, about half of the studied patients were below normal as assessed by hand grip strength test. About one fifth of the studied patients were severely malnourished when assessed by weight for age, MAC, TSF, MAMC and MAMA.
Regarding biochemical assessment: Abnormally high values of different laboratory results were present in different percents of the studied patients.
Regarding dietary assessment: There was low frequency as concern consumption of meat and other protein containing food stuffs. On the other hand, there was a large percent of the studied patients had inadequate total energy consumption.
Regarding relationship between chronic Hepatic Disease Severity and Malnutrition assessed by different tools was studied: There was a statistically significant difference between the three Child groups as regards PG-SGA, RFH-SGA and many anthropometric and biochemical parameters. In addition to that, the mean of total energy, protein, carbohydrates and fats intake for Child A group was higher than that for Child B and C.
Regarding the comparison between inpatients and outpatients: There was a statistically significant difference between them as regards different nutritional assessment methods.
Regarding compliance of the Studied chronic Hepatic Patients with the Current International Nutritional Guidelines (ESPEN and ASPEN): About fifth of the studied patients were compliant to recommended daily energy intake, while two fifths are compliant to recommended protein intake. Child A patients had got the highest number of compliant patients as compared to Child B and C patients, as regards total energy and protein intake. About two fifths (37.9%) of the studied patients received nutritional advices and were compliant to having regular meals, followed by intake of a late evening snack, nutritional supplements intake while only a very small percent of the patients were compliant to receiving small frequent (4 to 6) meals.
Recommendations include early routine nutritional screening for the outpatients with chronic liver disease, the importance of further studies to develop our own national guidelines and development of a national reference database of anthropometric measurements of the Egyptian population. In addition, Counseling for the patient and the care giver especially during the hospital stay can improve the nutritional status of the chronic hepatic patients.