Malnutrition, a quiet problem in children with chronic liver disease (CLD) is associated with short and long-term morbidity and mortality in both pre- and post-transplant periods Its prevalence depends upon the severity of underlying liver disease and the methods used to appraise nutritional status.

Nehal and colleague conducted a trial to determine the nutritional status of children with CLD. In addition,   the anthropometric indices was also evaluated with the severity of liver disease, liver function tests, insulin growth factor-1 (IGF-1) and 25-hydroxy vitamin D (25- OH D).  The study included 69 patients with CLD and 50 healthy controls. Nutritional status was analyzed by anthropometric indices expressed in standard deviation score (Z score), biochemical, hematological and clinical parameters.

Outcome demonstrated that 52.2% of CLD patients were underweight by weight for age (W/A) while 50.2% were stunted by height for age/ length for age (HAZ or LAZ); and 39% exhibited wasting 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 were significantly correlated with unconjugated and conjugated bilirubin and international normalized ratio (INR), except HAZ or LAZ. Moreover, correlation was found between malnutrition and albumin, except for W/HZ or (W/LZ). The z scores < − 2 SD based on W/ H versus arm indicators showed significant differences in mid-upper arm circumference-for-age (MUAC/A), upper arm area (UAA) and arm muscle area (AMA). Besides, no correlation was found between anthropometric z-scores and the mean IGF-1 and 25- OH D values. Malnutrition had a direct association with the severity of hepatic dysfunction, especially, Child-Pugh C cases. Additionally, the mean IGF-1 and 25- OH D values were found to have significant correlation with the severity of liver disease.

Therefore, it can be established that anthropometric arm indicators and MUAC/A measurements are important diagnostic tools for evaluating nutritional status in CLD children. Appropriate assessment, follow-up and management of CLD children with variable degree of malnutrition warrants integrating comprehensive clinical assessment, anthropometric measurements and objective biochemical analyses.

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 Gastroenterol. 2019;19(1):223. Published 2019 Dec 21. doi:10.1186/s12876-019-1145-3