Background: Protein calorie malnutrition (PCM) is present in chronic liver disease (CLD) patients and the degree is directly related to the severity of the disease. We carried out this study to determine the prevalence of PCM in CLD patients and to assess the impact of nutritional supplementation on the nutritional status and clinical outcome using a customized diet chart. Methodology: A Prospective interventional clinical study was conducted on 65 CLD patients in Shree Krishna Hospital, Karamsad, Gujarat. Socio demographic characteristics of all patients collected and nutritional status assessment was done by Modified Subjective Global assessment, Anthropometry, Hand grip dynamometer and Serum albumin. Diet was assessed by 24 hour recall and diet modification as high carbohydrate, high protein and low fat with vitamin supplementation as per recommended daily allowance was done according to customized diet chart. Patient compliance was verified telephonically once every fifteen days initially for one month and then every month for six months by 24 hour diet recall and a diet diary. Reassessment of nutritional status was done after 3 and 6 months using the same parameters. The degree of morbidity by Child Pugh score and D’Amico clinical staging of cirrhosis, mortality and frequency of hospitalization was assessed. Results: Prevalence of malnutrition by indices: Body Mass Index-16.92 %, Mid Arm Circumference - 67.69%, modified Subjective Global Assessment (SGA) -80%, Serum albumin -87.69 %, Mid Arm Muscle Circumference (MAMC)-96.92%, Triceps Skin Fold Thickness and Hand Grip strength -100%. There was a statistically significant correlation (p<0.001) between reduction of CLD severity as assessed by CPS and D’ Amico staging and increasing concentration of serum albumin after nutritional supplementation. There was also a statistically significant improvement in nutritional status as evidenced by an increase in BMI from 21.75 to 22.04 kg/m2 (p=0.016), increase in serum albumin from 2.42 to 2.59 mg/dl (value -0.008) and improvement in modified SGA grading (p=0.03). There was a significant decrease in the CLD severity score CPS (mean +SD 9.11+2.24 to 8.71+_2.27; before and after nutritional intervention respectively) and improvement in staging by D’Amico (from stage 3 to stage 1 patients by 19.14%) after nutritional supplementation. There was a significant decrease in number of hospitalizations with mortality of 1.67%. Conclusion: Malnutrition in CLD patients improved significantly after nutritional supplementation as seen by improvement in BMI and modified SGA. There was a statistically significant improvement in the severity of CLD accompanied by a decrease in frequency of hospitalization and lower mortality rate upon nutritional supplementation.
