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

Purpose 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. Methods 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. Results 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). Conclusion 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.