B0518 - The Prevalence of Protein-Calorie Malnutrition Among Patients With Alcoholic, Non-Alcoholic and Chronic Viral Cirrhosis in the United States: A Population-Based Study

Introduction: Malnutrition is commonly identified among patients with cirrhosis with a wide prevalence rate of 23-60%, and is associated with increased mortality and liver-related complications like hepatic encephalopathy, infections and ascites. Our aim is to identify the prevalence of protein-calorie malnutrition among patients with alcoholic, non-alcoholic and chronic viral cirrhosis in the United States.

Methods: A validated multicenter database (Explorys Inc) of more than 360 hospitals from 26 different healthcare systems and ~70 million patients across the United States was utilized for this study. A cohort of patients with a SNOMED-CT diagnosis of “Protein-Calorie Malnutrition” between 2016-2021 was identified. We excluded all patients with age < 18 years, pregnancy, eating disorders, Roux-en-Y gastrojejunostomy, celiac disease, chronic pancreatitis and liver transplant. Statistical Package for Social Sciences (SPSS version 25, IBM Corp) was used for statistical analysis, and for all analyses, a 2-sided p-value of < 0.05 was considered statistically significant. Multivariate analysis was performed to adjust for multiple factors including age, sex, race, smoking, intravenous drug abuse, alcohol abuse, alcoholic cirrhosis, non-alcoholic fatty liver disease cirrhosis, and chronic hepatitis B or C cirrhosis.

Results: 74,226,890 individuals were screened in the database and 276,720,70 were included in the final analysis. The prevalence of malnutrition was 1.2%. The baselines characteristics of patients with protein-calorie malnutrition is shown in Table 1. The prevalence of protein-calorie malnutrition among patients with alcoholic, non-alcoholic and chronic hepatitis B or C cirrhosis was 10.9%, 6.9% and 2.0%; respectively. Elderly (OR 4.24), females (OR 1.43) and Caucasians (OR 1.39) were at higher risk for malnutrition. Protein-calorie malnutrition was more common among patients with alcoholic (OR 6.34), non-alcoholic fatty liver (OR 4.27) and chronic hepatitis B or C. Active smoking (OR 3.12), alcoholism (OR 3.45) and IV drug abuse (OR 3.77) were independently associated with higher risk for malnutrition (Table 2).

Discussion: This is the largest study for the prevalence of malnutrition in the U.S. Alcoholic cirrhosis, followed by non-alcoholic and chronic hepatitis B/C cirrhosis are associated with significantly increased risk. Independently of the liver status, active smoking, alcoholism and IV drug abuse are associated with higher risk for protein-calorie malnutrition.