Nutrition impact symptoms are related to malnutrition and quality of life - A cross-sectional study of patients with chronic liver disease

Background and aims: Patients with chronic liver disease often experience symptoms that affect their ability to eat. These symptoms can contribute to weight loss and malnutrition. We aimed to examine the prevalence of nutrition impact symptoms (NIS) in patients with chronic liver disease, and to investigate the relationships between NIS, malnutrition and health-related quality of life. Methods: In a cross-sectional study on adult patients with chronic liver disease under evaluation for liver transplantation, we studied NIS with two questionnaires: the Eating Symptoms Questionnaire and the Disease-Related Appetite Questionnaire. Malnutrition was primarily assessed with the Global Leadership Initiative on Malnutrition (GLIM) criteria. Health-related quality of life (HRQOL) was assessed with the Chronic Liver Disease Questionnaire. Results: Among the 133 included patients, 90% reported one or more NIS and 51% reported four or more NIS. The most common symptoms were dry mouth (61%), abdominal pain (58%), diarrhoea (45%) and nausea (41%). Malnutrition was present in 32% according to GLIM criteria. Malnourished patients reported more NIS (p = 0.004) and had lower HRQOL (p < 0.001). Certain NIS, such as pain, poor appetite, changes in taste and early satiety, were predictors for malnutrition. Conclusions: NIS are common in patients with chronic liver disease and are associated with malnutrition and worse HRQOL. NIS should therefore be systematically assessed in patients with chronic liver disease. Whether identification and proper management of NIS can prevent malnutrition and improve quality of life deserves further exploration. (C) 2019 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.