Liver cirrhosis is a systemic disease where the prevalence of malnutrition is noticed in around 20% of compensated and 60% of decompensated cirrhosis. Though common, malnutrition is overlooked, and assessment for malnutrition is ignored, which has a profound negative impact on the disease progression and outcomes.1 Malnutrition is associated with reduced quality of life, frequent infections, increased duration of hospitalization and admissions, as well as doubled morbidity and mortality.2 Malnutrition being an independent predictor of clinical outcome, periodic screening for the same is recommended to identify the levels of malnutrition and ‘at risk’ groups which may further emerge in the timely and appropriate care of patients and to prevent further complications.3

The aetiology of malnutrition is multifactorial in liver diseases. Inadequate calorie and protein intake, which occurs due to impaired gastric motility, portal hypertension, presence of ascites causing early satiety, dietary restrictions causing food unpalatability, malabsorption leading to macro and micronutrient deficiencies, increased alcohol intake, prolonged fasting periods and gut microbiome dysbiosis are potential contributors to malnutrition. 4

Based on the guidelines of the European Association for the Study of the Liver (EASL) on clinical practices to determine the severity of malnutrition, all patients with liver cirrhosis should be pre-screened for malnutrition, and they should undergo detailed nutritional assessment and assessment for sarcopenia either during the outpatient visit or during hospitalisation.5 In patients with low risk for malnutrition, screening can be performed yearly, and in moderate to high-risk patients, screening can be performed at least once every three months.5 However, assessment is challenging due to fluid retention, ascites, and pedal oedema. A good nutrition screening tool should be simple and easy to use with relatively good sensitivity and specificity. 6 Clinically various bedside tools like body mass index (BMI), mid-arm circumference (MAC), triceps skin fold thickness (TSF), mid-arm muscle circumference (MAMC), hang grip strength (HGS) and subjective global assessments (SGA) were used to assess the nutritional status; however, each tool has its limitations when applied to these group of patients. Although highly sophisticated tools like bioelectrical impedance analysis (BIA) and dual-energy x-ray absorptiometry (DEXA) are accurate, their usage is limited due to their cost, less availability and radiation exposure.7,8 Despite limitations, current guidelines recommend using bedside tools for nutritional assessment.9 Hence in this current study, we have aimed to assess the prevalence of malnutrition using simple bedside tools among patients with cirrhosis referred for LT.