{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,11]],"date-time":"2025-09-11T21:16:12Z","timestamp":1757625372809,"version":"3.44.0"},"reference-count":32,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","license":[{"start":{"date-parts":[[2025,1,3]],"date-time":"2025-01-03T00:00:00Z","timestamp":1735862400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,1,3]]},"abstract":"<jats:p>Liver cirrhosis is a major health burden, resulting in over 1 million deaths per year worldwide. Nutritional imbalance often complicates the course of liver diseases, particularly of cirrhosis and has been linked to increased mortality. Despite the high disease burden, there is paucity of literature regarding the magnitude of under-nutrition in patients with cirrhosis and its associated factors in Ethiopia and sub-Saharan Africa. The study aimed to assess the prevalence of under-nutrition and its associated factors among adult out-patients with liver cirrhosis. A hospital-based cross-sectional study was conducted among 136 adult out-patients with cirrhosis who visited the hepatology clinic of St. Paul\u2019s Hospital Millennium Medical College. Data were obtained through patient interviews, medical record reviews, anthropometric and handgrip strength measurements and collected using a structured checklist and analyzed using Statistical Package for the Social Sciences (SPSS) version 26.0. Body mass index with cutoff points adjusted for the degree of ascites were used to diagnose under-nutrition. Descriptive statistical tools and binary and multivariable logistic regression analyses were employed, and statistical significance was set at &lt;0.05. The mean age of study participants was 39.5 years (standard deviation: \u00b111.2) and 62.5% were males. Chronic hepatitis B virus infection (57.4%) was the most common cause of liver cirrhosis, followed by alcohol-associated liver cirrhosis (12.5%). The majority (70.6%) of the study participants were undernourished. The factors found to have statistically significant association with under-nutrition were, rural area of residence (adjusted odds ratios [AOR]: 5.65, 95% confidence interval [CI]: 1.98\u201316.1), presence of ascites (AOR: 2.43, 95% CI: 1.03\u20135.7) and the disease severity, as measured by the child\u2013pugh class (AOR, 1.11; 95% CI: 0.45\u20132.7). Under-nutrition was found to be a common problem among out-patients with liver cirrhosis and patients from rural areas and those with advanced disease were disproportionately affected. It is imperative to implement routine nutritional screening and plan on appropriate interventions for patients with liver cirrhosis.<\/jats:p>","DOI":"10.1097\/md.0000000000041226","type":"journal-article","created":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T14:05:20Z","timestamp":1736258720000},"page":"e41226","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence of under-nutrition and associated factors among patients with liver cirrhosis at a tertiary hospital in Ethiopia"],"prefix":"10.1097","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-1089-3457","authenticated-orcid":false,"given":"Biruk","family":"Mulugeta","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, St. Paul\u2019s Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6195-1251","authenticated-orcid":false,"given":"Henok","family":"Fisseha","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, St. Paul\u2019s Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4198-0960","authenticated-orcid":false,"given":"Abel Mureja","family":"Argaw","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, St. Paul\u2019s Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9035-3824","authenticated-orcid":false,"given":"Rodas","family":"Kassu","sequence":"additional","affiliation":[{"name":"Division of Neurosurgery, University of Wisconsin, IL."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2042-5797","authenticated-orcid":false,"given":"Hailemichael","family":"Desalegn","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, St. Paul\u2019s Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","reference":[{"key":"R1-20250909","doi-asserted-by":"crossref","first-page":"875","DOI":"10.3390\/cells9040875","article-title":"Liver fibrosis: mechanistic concepts and therapeutic perspectives.","volume":"9","author":"Roehlen","year":"2020","journal-title":"Cells"},{"key":"R2-20250909","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1016\/S2468-1253(19)30349-8","article-title":"The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.","volume":"5","year":"2020","journal-title":"Lancet Gastroenterol Hepatol"},{"key":"R3-20250909","doi-asserted-by":"crossref","first-page":"2650","DOI":"10.1016\/j.cgh.2019.07.060","article-title":"Contemporary epidemiology of chronic liver disease and cirrhosis.","volume":"18","author":"Moon","year":"2020","journal-title":"Clin Gastroenterol Hepatol"},{"key":"R4-20250909","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.jhep.2018.06.024","article-title":"EASL clinical practice guidelines on nutrition in chronic liver disease.","volume":"70","year":"2019","journal-title":"J Hepatol"},{"key":"R5-20250909","doi-asserted-by":"crossref","first-page":"685","DOI":"10.4254\/wjh.v10.i10.685","article-title":"Nutritional support in chronic liver disease and cirrhotics.","volume":"10","author":"Shergill","year":"2018","journal-title":"World J Hepatol"},{"key":"R6-20250909","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.cld.2013.09.004","article-title":"Nutrition in cirrhosis and chronic liver disease nutrition assessment management.","volume":"18","author":"Juakiem","year":"2014","journal-title":"Clin Liver Dis"},{"key":"R7-20250909","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.cgh.2011.08.016","article-title":"Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies.","volume":"10","author":"Cheung","year":"2012","journal-title":"Clin Gastroenterol Hepatol"},{"key":"R8-20250909","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1111\/j.1440-1746.2008.05369.x","article-title":"Malnutrition in end stage liver disease: recommendations and nutritional support.","volume":"23","author":"Tsiaousi","year":"2008","journal-title":"J Gastroenterol Hepatol"},{"key":"R9-20250909","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s12876-019-0993-1","article-title":"Predictors of mortality in patients under treatment for chronic hepatitis B in Ethiopia: a prospective cohort study.","volume":"19","author":"Desalegn","year":"2019","journal-title":"BMC Gastroenterol"},{"key":"R10-20250909","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1016\/j.nut.2013.03.017","article-title":"Nutritional assessment and treatment of patients with liver cirrhosis.","volume":"29","author":"Moctezuma-Vel\u00e1zquez","year":"2013","journal-title":"Nutrition"},{"key":"R11-20250909","first-page":"1","article-title":"Review: nutrition on chronic liver diseases.","volume":"1","author":"Zehra","year":"2017","journal-title":"SL Gastroenterol"},{"key":"R12-20250909","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/S0899-9007(01)00626-8","article-title":"Nutritional assessment in various stages of liver cirrhosis.","volume":"17","author":"Roongpisuthipong","year":"2001","journal-title":"Nutrition"},{"key":"R13-20250909","first-page":"687","article-title":"Nutritional assessment of patients with chronic liver disease.","volume":"8","author":"Patton","year":"2012","journal-title":"Gastroenterol Hepatol (NY)"},{"key":"R14-20250909","first-page":"1","article-title":"Nutrition and food sciences protein calorie malnutrition in liver cirrhosis.","volume":"5","author":"Sidiq","year":"2014","journal-title":"J Nutr Food Sci"},{"key":"R15-20250909","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13104-018-3640-y","article-title":"Assessment of malnutrition in patients with liver cirrhosis using protein calorie malnutrition (PCM) score verses bio-electrical impedance analysis (BIA).","volume":"11","author":"Parkash","year":"2018","journal-title":"BMC Res Notes"},{"key":"R16-20250909","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1093\/ajcn\/63.4.602","article-title":"Malnutrition in alcoholic and virus-related cirrhosis.","volume":"63","author":"Caregaro","year":"1996","journal-title":"Am J Clin Nutr"},{"key":"R17-20250909","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1016\/S0399-8320(06)73491-1","article-title":"Validation of body mass index for the diagnosis of malnutrition in patients with liver cirrhosis.","volume":"30","author":"Campillo","year":"2006","journal-title":"Gastroenterol Clin Biol"},{"key":"R18-20250909","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.jceh.2016.10.005","article-title":"Handgrip strength as an important bed side tool to assess malnutrition in patient with liver disease.","volume":"7","author":"Sharma","year":"2017","journal-title":"J Clin Exp Hepatol"},{"key":"R19-20250909","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1007\/s11011-016-9828-8","article-title":"Lower values of handgrip strength and adductor pollicis muscle thickness are associated with hepatic encephalopathy manifestations in cirrhotic patients.","volume":"31","author":"Augusti","year":"2016","journal-title":"Metab Brain Dis"},{"key":"R20-20250909","first-page":"509","article-title":"Handgrip dynamometry: a surrogate marker of malnutrition to predict the prognosis in alcoholic liver disease.","volume":"29","author":"Gaikwad","year":"2016","journal-title":"Ann Gastroenterol"},{"key":"R21-20250909","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.nut.2004.02.002","article-title":"Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients.","volume":"21","author":"\u00c1lvares-Da-Silva","year":"2005","journal-title":"Nutrition"},{"key":"R22-20250909","first-page":"120","article-title":"Etiology of chronic liver disease in Ethiopia: a case control study with special reference to viral hepatitis and alcohol.","volume":"5","author":"Abdelmenan","year":"2018","journal-title":"EC Gastroenterol Dig Syst"},{"key":"R23-20250909","first-page":"267","article-title":"Magnitude, clinical profile and hospital outcome of chronic liver disease at St. Paul\u2019s Hospital Millennium Medical.","volume":"55","author":"Mulugeta","year":"2017","journal-title":"Ethiop Med J"},{"key":"R24-20250909","article-title":"About \u2013 Saint Paul\u2019s Millennium Medical College."},{"key":"R25-20250909","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1053\/jhep.2003.50315","article-title":"The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club.","volume":"38","author":"Moore","year":"2003","journal-title":"Hepatology"},{"key":"R27-20250909","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1016\/S0140-6736(14)62000-6","article-title":"Prognostic value of grip strength: findings from the Prospective Urban Rural Epidemiology (PURE) study.","volume":"386","author":"Leong","year":"2015","journal-title":"Lancet"},{"key":"R28-20250909","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1590\/S0004-28032006000400005","article-title":"Evaluation of nutritional status of nonhospitalized patients with liver cirrhosis.","volume":"43","author":"Carvalho","year":"2006","journal-title":"Arq Gastroenterol"},{"key":"R29-20250909","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/S0899-9007(01)00521-4","article-title":"Nutrition and survival in patients with liver cirrhosis.","volume":"17","author":"Alberino","year":"2001","journal-title":"Nutrition"},{"key":"R30-20250909","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1097\/MEG.0b013e32834aa4bb","article-title":"Protein energy malnutrition predicts complications in liver cirrhosis.","volume":"23","author":"Huisman","year":"2011","journal-title":"Eur J Gastroenterol Hepatol"},{"key":"R31-20250909","first-page":"76","article-title":"Evaluation of nutritional status in patients with liver cirrhosis.","volume":"88","author":"Fatma","year":"2010","journal-title":"Tunis Med"},{"key":"R32-20250909","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1016\/S0899-9007(02)01071-7","article-title":"Evaluation of nutritional practice in hospitalized cirrhotic patients: results of a prospective study.","volume":"19","author":"Campillo","year":"2003","journal-title":"Nutrition"},{"key":"R33-20250909","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1007\/s11894-019-0706-5","article-title":"Nutrition in cirrhosis.","volume":"21","author":"Palmer","year":"2019","journal-title":"Curr Gastroenterol Rep"}],"container-title":["Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000041226","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T18:01:29Z","timestamp":1757440889000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/MD.0000000000041226"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,3]]},"references-count":32,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1097\/md.0000000000041226","relation":{},"ISSN":["1536-5964"],"issn-type":[{"type":"electronic","value":"1536-5964"}],"subject":[],"published":{"date-parts":[[2025,1,3]]}}}