{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T02:52:05Z","timestamp":1772765525804,"version":"3.50.1"},"reference-count":41,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T00:00:00Z","timestamp":1738713600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Liver cirrhosis is associated with significant nutritional challenges, including malnutrition, sarcopenia, and frailty, which impact clinical outcomes. The severity of these issues may vary between inpatient and outpatient settings, but there is a limited understanding of how these conditions manifest in these populations. This study aims to compare the nutritional status, dietary intake, and frailty in outpatients and inpatients with liver cirrhosis and to explore potential sex-specific differences. Methods: This prospective observational study enrolled 195 patients with liver cirrhosis from the Gastroenterology ward and Outpatient Clinic of Policlinico Umberto I, Sapienza University of Rome, between May 2023 and July 2024. Nutritional status was assessed using anthropometric measurements, dietary recall, and food frequency questionnaires. Sarcopenia was evaluated using the SARC-F questionnaire and handgrip strength. Frailty was assessed using the Liver Frailty Index (LFI). Data on clinical characteristics, comorbidities, and disease severity were also recorded. Results: The inpatient group (n = 69) had significantly lower BMI, mid-upper arm circumference, and triceps skinfold compared to outpatients (n = 126). Inpatients exhibited higher frailty, with 73.9% classified as frail according to the LFI, compared to 39.6% in outpatients (p &lt; 0.001). Dietary intake revealed that 91% of inpatients had an energy intake deficit compared to 76% of outpatients (p = 0.009). Protein intake was inadequate in 84% of inpatients versus 61% of outpatients (p &lt; 0.001). Sex-specific analysis showed that females had a higher prevalence of sarcopenia than males (64.4% vs. 38.2%, p &lt; 0.001) and experienced more significant protein deficits (74.3% vs. 57.6%, p = 0.021). Females also had higher LFI score (4.77 \u00b1 0.88 vs. 4.45 \u00b1 0.91, p = 0.034). Multivariate analysis showed that CTP, LFI, and protein deficit are independently associated with hospitalization. Conclusions: Inpatients with liver cirrhosis are at higher risk for malnutrition, frailty, and inadequate nutrient intake compared to outpatients, emphasizing the need for targeted nutritional interventions in hospital settings. Additionally, females with cirrhosis are more prone to sarcopenia and frailty, requiring gender-specific approaches to nutrition.<\/jats:p>","DOI":"10.3390\/nu17030580","type":"journal-article","created":{"date-parts":[[2025,2,5]],"date-time":"2025-02-05T05:50:36Z","timestamp":1738734636000},"page":"580","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["A Comparative Study of Dietary Intake, Nutritional Status, and Frailty in Outpatients and Inpatients with Liver Cirrhosis"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8883-4604","authenticated-orcid":false,"given":"Saniya","family":"Khan","sequence":"first","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sara","family":"Sansoni","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6414-4404","authenticated-orcid":false,"given":"Simone","family":"Di Cola","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6761-4969","authenticated-orcid":false,"given":"Lucia","family":"Lapenna","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3173-9767","authenticated-orcid":false,"given":"Manuela","family":"Merli","sequence":"additional","affiliation":[{"name":"Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Lai, J.C., Tandon, P., Bernal, W., Tapper, E.B., Ekong, U., Dasarathy, S., and Carey, E.J. (2021). Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology, 74.","DOI":"10.1002\/hep.32049"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Kusnik, A., Penmetsa, A., Chaudhary, F., Renjith, K., Ramaraju, G., Laryea, M., and Allard, J.P. (2024). Clinical Overview of Sarcopenia, Frailty, and Malnutrition in Patients With Liver Cirrhosis. Gastroenterol. Res., 17.","DOI":"10.14740\/gr1707"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"563","DOI":"10.1111\/j.1365-2036.2006.03003.x","article-title":"Nutritional Status and Prognosis in Cirrhotic Patients","volume":"24","author":"Gunsar","year":"2006","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1002\/hep.510230516","article-title":"Does Malnutrition Affect Survival in Cirrhosis? The Present Report Analyzes Prospectively the 5-Year From the 1 II Cattedra Di Gastroenterologia and the 2 Laboratorio Di Epide-Survival of a Large Series of Cirrhotic Patients, Originally","volume":"5","author":"Merli","year":"1996","journal-title":"Hepatology"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Traub, J., Reiss, L., Aliwa, B., and Stadlbauer, V. (2021). Malnutrition in Patients with Liver Cirrhosis. Nutrients, 13.","DOI":"10.3390\/nu13020540"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Anand, A.C. (2017). Nutrition and Muscle in Cirrhosis. J. Clin. Exp. Hepatol., 7.","DOI":"10.1016\/j.jceh.2017.11.001"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Stirnimann, J., and Stirnimann, G. (2019). Nutritional Challenges in Patients with Advanced Liver Cirrhosis. J. Clin. Med., 8.","DOI":"10.3390\/jcm8111926"},{"key":"ref_8","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","author":"Merli","year":"2018","journal-title":"J. Hepatol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Licata, A., Zerbo, M., Como, S., Cammilleri, M., Soresi, M., Montalto, G., and Giannitrapani, L. (2021). The Role of Vitamin Deficiency in Liver Disease: To Supplement or Not Supplement?. Nutrients, 13.","DOI":"10.3390\/nu13114014"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S147","DOI":"10.1016\/j.jhep.2021.01.025","article-title":"Sarcopenia and Frailty in Decompensated Cirrhosis","volume":"75","author":"Tandon","year":"2021","journal-title":"J. Hepatol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Italian Multicentre Cooperative Project on nutrition in liver cirrhosis (1994). Nutritional Status in Cirrhosis. J. Hepatol., 21, 317\u2013325.","DOI":"10.1016\/S0168-8278(05)80308-3"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"600","DOI":"10.1002\/hep.32157","article-title":"Frailty Is Associated with Increased Risk of Cirrhosis Disease Progression and Death","volume":"75","author":"Wang","year":"2022","journal-title":"Hepatology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"S70","DOI":"10.1016\/j.dld.2024.01.124","article-title":"Liver Frailty Index Predicts Poor Outcomes in Patients Hospitalized for Acute Decompensation of Cirrhosis","volume":"56","author":"Gagliardi","year":"2024","journal-title":"Dig. Liver Dis."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Lai, J.C., Rahimi, R.S., Verna, E.C., Kappus, M.R., Dunn, M.A., McAdams-DeMarco, M., Haugen, C.E., Volk, M.L., Duarte-Rojo, A., and Ganger, D.R. (2019). Frailty Associated With Waitlist Mortality Independent of Ascites and Hepatic Encephalopathy in a Multi-Center Study. Gastroenterology, 156.","DOI":"10.1053\/j.gastro.2019.01.028"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1177\/0260106019888362","article-title":"Assessing Nutritional Status in a Cohort of Liver Cirrhosis Outpatients: A Prospective Cross-Sectional Study","volume":"26","author":"Luong","year":"2020","journal-title":"Nutr. Health"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1017\/S0007114519002277","article-title":"Evaluation of the Effectiveness of Eight Screening Tools in Detecting Risk of Malnutrition in Cirrhotic Patients: The KIRRHOS Study","volume":"122","author":"Georgiou","year":"2019","journal-title":"Br. J. Nutr."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Janota, B., Krupowicz, A., Noras, K., and Janczewska, E. (2023). Evaluation of the Nutritional Status of Patients with Liver Cirrhosis. World J. Hepatol., 15.","DOI":"10.4254\/wjh.v15.i7.914"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"\u0141api\u0144ski, T.W., and \u0141api\u0144ska, M. (2019). Nutritional Status in Patients with Liver Cirrhosis. Clin. Exp. Hepatol., 5.","DOI":"10.5114\/ceh.2019.83154"},{"key":"ref_19","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":"ref_20","first-page":"63","article-title":"Evaluation of Nutritional Status in Patients with Liver Cirrhosis","volume":"88","author":"Houissa","year":"2010","journal-title":"Tunis. Med."},{"key":"ref_21","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":"ref_22","doi-asserted-by":"crossref","unstructured":"Huynh, D.K., Selvanderan, S.P., Harley, H.A.J., Holloway, R.H., and Nguyen, N.Q. (2015). Nutritional Care in Hospitalized Patients with Chronic Liver Disease. World J. Gastroenterol., 21.","DOI":"10.3748\/wjg.v21.i45.12835"},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Sharma, P., Gupta, C., Kumar, A., Arora, A., Anikhindi, S.A., Singla, V., Bansal, N., and Jasrotia, S. (2021). Nutritional Assessment and Factors Affecting Dietary Intake in Patients with Cirrhosis: A Single-Center Observational Study. Nutrition, 84.","DOI":"10.1016\/j.nut.2020.111099"},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Topan, M.M., Sporea, I., D\u0103nil\u0103, M., Popescu, A., Ghiuchici, A.M., Lupu\u0219oru, R., and \u0218irli, R. (2023). Association between Dietary Habits and Sarcopenia in Patients with Liver Cirrhosis. J. Clin. Med., 12.","DOI":"10.3390\/jcm12144693"},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Palmese, F., Bolondi, I., Giannone, F.A., Zaccherini, G., Tufoni, M., Baldassarre, M., and Caraceni, P. (2019). The Analysis of Food Intake in Patients with Cirrhosis Waiting for Liver Transplantation: A Neglected Step in the Nutritional Assessment. Nutrients, 11.","DOI":"10.3390\/nu11102462"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2896","DOI":"10.17554\/j.issn.2224-3992.2019.08.823","article-title":"Low Adherence To Nutritional Recommendations In Patients With Cirrhosis: A Prospective Observational Study","volume":"8","author":"Palmese","year":"2019","journal-title":"J. Gastroenterol. Hepatol. Res."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"e16","DOI":"10.1016\/j.dld.2015.12.047","article-title":"Management of Malnutrition in Patients with Cirrhosis Requires a Personalized Educational Approach","volume":"48","author":"Giannone","year":"2016","journal-title":"Dig. Liver Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1002\/lt.23495","article-title":"Severe Muscle Depletion in Patients on the Liver Transplant Wait List: Its Prevalence and Independent Prognostic Value","volume":"18","author":"Tandon","year":"2012","journal-title":"Liver Transplant."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Topan, M.M., Sporea, I., D\u0103nil\u0103, M., Popescu, A., Ghiuchici, A.M., Lupu\u0219oru, R., and \u0218irli, R. (2022). Comparison of Different Nutritional Assessment Tools in Detecting Malnutrition and Sarcopenia among Cirrhotic Patients. Diagnostics, 12.","DOI":"10.3390\/diagnostics12040893"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2540","DOI":"10.1093\/ajcn\/34.11.2540","article-title":"New Norms of Upper Limb Fat and Muscle Areas for Assessment of Nutritional Status","volume":"34","author":"Frisancho","year":"1981","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"M146","DOI":"10.1093\/gerona\/56.3.M146","article-title":"Frailty in Older Adults: Evidence for a Phenotype","volume":"56","author":"Fried","year":"2001","journal-title":"J. Gerontol. Ser. A"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Dodds, R.M., Syddall, H.E., Cooper, R., Benzeval, M., Deary, I.J., Dennison, E.M., Der, G., Gale, C.R., Inskip, H.M., and Jagger, C. (2014). Grip Strength across the Life Course: Normative Data from Twelve British Studies. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0113637"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Buchard, B., Boirie, Y., Cassagnes, L., Lamblin, G., Coilly, A., and Abergel, A. (2020). Assessment of Malnutrition, Sarcopenia and Frailty in Patients with Cirrhosis: Which Tools Should We Use in Clinical Practice?. Nutrients, 12.","DOI":"10.3390\/nu12010186"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Lai, J.C., Covinsky, K.E., Dodge, J.L., Boscardin, W.J., Segev, D.L., Roberts, J.P., and Feng, S. (2017). Development of a Novel Frailty Index to Predict Mortality in Patients with End-Stage Liver Disease. Hepatology, 66.","DOI":"10.1002\/hep.29219"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"531","DOI":"10.1016\/j.jamda.2013.05.018","article-title":"SARC-F: A Simple Questionnaire to Rapidly Diagnose Sarcopenia","volume":"14","author":"Malmstrom","year":"2013","journal-title":"J. Am. Med. Dir. Assoc."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Putadechakum, S., Klangjareonchai, T., Soponsaritsuk, A., and Roongpisuthipong, C. (2012). Nutritional Status Assessment in Cirrhotic Patients after Protein Supplementation. ISRN Gastroenterol., 2012.","DOI":"10.5402\/2012\/690402"},{"key":"ref_37","first-page":"9","article-title":"Effect of a High-Protein, High-Fiber Diet plus Supplementation with Branched-Chain Amino Acids on the Nutritional Status of Patients with Cirrhosis","volume":"83","author":"Torre","year":"2018","journal-title":"Rev. Gastroenterol. M\u00e9xico"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"190","DOI":"10.3390\/livers3020013","article-title":"Principles of Nutritional Management in Patients with Liver Dysfunction\u2014A Narrative Review","volume":"3","author":"Elsebaie","year":"2023","journal-title":"Livers"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1418","DOI":"10.1016\/j.nut.2013.05.016","article-title":"Nutrition Therapy Using a Multidisciplinary Team Improves Survival Rates in Patients with Liver Cirrhosis","volume":"29","author":"Iwasa","year":"2013","journal-title":"Nutrition"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"S73","DOI":"10.1017\/S0007114509990602","article-title":"Misreporting of Energy and Micronutrient Intake Estimated by Food Records and 24 Hour Recalls, Control and Adjustment Methods in Practice","volume":"101","author":"Poslusna","year":"2009","journal-title":"Br. J. Nutr."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"7307","DOI":"10.3402\/fnr.v55i0.7307","article-title":"Repeated 24-Hour Recalls versus Dietary Records for Estimating Nutrient Intakes in a National Food Consumption Survey","volume":"55","author":"Huybrechts","year":"2011","journal-title":"Food Nutr. Res."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/3\/580\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:27:06Z","timestamp":1760027226000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/17\/3\/580"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,2,5]]},"references-count":41,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,2]]}},"alternative-id":["nu17030580"],"URL":"https:\/\/doi.org\/10.3390\/nu17030580","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,2,5]]}}}