# Prevalence and Impact of Protein-Calorie Malnutrition in Hospitalized Patients with Steatotic Liver Disease

## TL;DR

This study finds that protein-calorie malnutrition is more common in hospitalized patients with liver disease and is linked to higher death rates and healthcare costs.

## Contribution

The study is the first to quantify the prevalence and impact of PCM in hospitalized patients with steatotic liver disease using a national database.

## Key findings

- PCM was significantly more prevalent in patients with ALD or MASLD compared to those with neither condition.
- PCM was associated with increased mortality, longer hospital stays, and higher charges in patients with ALD and MASLD.
- Early identification and management of PCM could reduce adverse outcomes and healthcare costs in steatotic liver disease patients.

## Abstract

Patients with liver disease often experience nutritional insufficiency due to an interplay of metabolic disturbances and dietary alterations leading to decreased muscle mass and the development of protein-calorie malnutrition (PCM). This study aimed to evaluate the prevalence of PCM in patients with steatotic liver disease (alcohol associated liver disease (ALD) and metabolic dysfunction-associated steatotic liver disease (MASLD)) and their impacts on mortality and healthcare utilization.

We identified hospitalizations with ALD, MASLD, and PCM using International Classification of Diseases codes in the National Inpatient Sample from 2016 to 2020. Descriptive analyses compared hospitalizations with and without PCM. Multivariable linear models adjusting for confounders evaluated the association between PCM and inpatient mortality, length of stay (LOS), and total charges.

PCM was found to be significantly more prevalent among hospitalizations with ALD or MASLD than those with neither (ALD: 175.5 vs 51.7; MASLD: 69.2 vs 52.9; neither: 51.5 per 1000 hospitalizations; P < 0.001). Among hospitalizations with ALD or MASLD, PCM was significantly associated with higher mortality (ALD: adjusted odds ratio [aOR] 1.85, 95% CI 1.79–1.91; MASLD: aOR 2.30, 95% CI 2.10–2.52), LOS (ALD: 3.91 days, 95% CI 3.80–4.01; MASLD: 5.17 days, 95% CI 5.00–5.33), and total charges (ALD: $47k higher charges, 95% CI $45k–$50k; MASLD: $60k higher charges, 95% CI $57k–$64k).

We found a higher prevalence of PCM among individuals with ALD compared to those with MASLD or neither condition. PCM was associated with increased mortality, LOS, and total charges in those with ALD and MASLD. Our findings underscore the importance of early identification and management of PCM in patients with steatotic liver disease to mitigate adverse outcomes and reduce healthcare utilization.