Early alterations in nutritional indices in metabolic dysfunction-associated steatotic liver disease-related cirrhosis

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BACKGROUND AND AIM: Metabolic dysfunction-associated steatotic liver disease (MASLD) is primarily driven by relative overnutrition. Dietary restrictions and weight loss through exercise are known to improve this condition. However, as MASLD progresses, adequate nutritional intake is required to prevent decompensated cirrhosis. Therefore, appropriate nutritional assessment tools are needed to guide the transition from dietary restriction to adequate nutritional intake. However, early risk indicators of malnutrition in MASLD, particularly before decompensated cirrhosis develops, remain unclear. This study aimed to explore nutritional markers indicative of deterioration in MASLD with cirrhosis. METHODS: This cross-sectional study included 154 patients (aged 18-79 years) diagnosed with MASLD by liver biopsy between October 2007 and June 2024 at Ehime University Hospital and received nutritional assessments during hospitalization. RESULTS: The Royal Free Hospital Nutritional Prioritizing Tool classified all patients as low risk. Multivariate analysis, adjusted for age, sex, body mass index, creatinine levels, and nonalcoholic fatty liver disease activity score, identified lower albumin, lower cholinesterase, higher hemoglobin A1c, lower total cholesterol, and lower low-density (LDL) cholesterol as independently associated with advanced fibrosis. However, no significant differences were observed in body composition, nutritional intake, and non-protein respiratory quotients. CONCLUSIONS: Blood indices reflecting protein syntheses, including albumin and cholinesterase, were useful makers for comprehending the change in nutritional status in MASLD-related cirrhosis. Clinicians should consider these markers when initiating timely changes in nutritional interventions for MASLD-related cirrhosis.

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