Malnutrition is a common occurrence among children with chronic liver diseases (CLD). Inadequate nutrient intake linked to anorexia, metabolic derangement, recurrent cholangitis and prolonged hospitalization seem to be the factors associated with malnutrition in patients with CLD.

By means of the present study, El Koofy and colleagues evaluated the nutritional status of children with CLD and sought to correlate the anthropometric indices with the severity of liver disease, liver function tests, insulin growth factor-1 (IGF-1) and 25-hydroxy vitamin D (25- OH D).

In all, 69 patients with CLD and 50 healthy controls, aged 6 months to 6 years, were recruited in the study. Investigators assessed the nutritional status of all the children using anthropometric indices expressed in standard deviation score (Z score), as well as biochemical, hematological and clinical characteristics.

Overall, 52.2% of CLD patients were found to be underweight by weight for age (W/A), 50.2% were stunted by height for age/length for age (HAZ or LAZ), and 39% were found to have wasting as assessed by weight/height or (length) for age (W/HZ or W/LZ) z scores analysis.

The mean values of z scores for all anthropometric parameters had a significant correlation with unconjugated and conjugated bilirubin and INR, except HAZ or LAZ. A significant correlation was also noted with albumin, except for W/HZ or W/LZ. The z scores < − 2 SD based on W/H versus arm indicators demonstrated significant differences in MUAC, UAA and AMA. There was no correlation between anthropometric z-scores and mean IGF-1 and 25-OH D levels. Malnutrition had a direct correlation with the severity of hepatic dysfunction, more so in Child-Pugh C cases. Mean IGF-1 and 25-OH D values demonstrated a significant correlation with liver disease severity.

The study outlined that anthropometric arm indicators and MUAC/A measurements are effective applied methods for assessing nutritional status in CLD children. It is important to integrate clinical assessment, anthropometric measurements and objective biochemical analyses to evaluate, follow-up and manage CLD children with varying levels of malnutrition.

Source: El Koofy N, Moawad EMI, Fahmy M, et al. Anthropometric, biochemical and clinical assessment of malnutrition among Egyptian children with chronic liver diseases: a single institutional cross-sectional study. BMC Gastroenterology 2019;19, Article number: 223.