P4610 - Prevalence and Impact of Protein-Calorie Malnutrition in Hospitalized Patients With Alcohol-Associated Liver Disease or Metabolic Dysfunction-Associated Steatotic Liver Disease

Sowon Kim, MD¹, Andrew Roney, MD², Alexandra C. Greb, MD², Berkeley Limketkai, MD, PhD², Po-Hung Chen, MD, PhD^3
1Olive View-UCLA Medical Center, Sylmar, CA; ²University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA; ³Johns Hopkins University School of Medicine, Baltimore, MD

Introduction: Patients with alcohol use disorder (AUD) and chronic liver disease often experience nutritional insufficiency due to a complex interplay of metabolic, absorption disturbances, and dietary alterations. They often rely on skeletal and visceral protein catabolism for energy, further contributing to decreased muscle mass and the development of protein-calorie malnutrition (PCM). Patients with alcohol-related liver disease (ALD) are particularly susceptible to PCM due to the combined physiological impacts of alcohol use and chronic liver disease. This study aims to evaluate the significance of alcohol use and steatotic liver disease on PCM and their associated impacts on mortality and healthcare utilization.

Methods: In this retrospective study, hospitalizations with ALD, metabolic dysfunction-associated steatotic liver disease (MASLD), and PCM were identified 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, and total charges.

Results: Among 174,776,205 hospitalizations, 2,276,264 (1.30%) had ALD, and 2,239,145 (1.28%) had MASLD. Significant demographic differences were observed between PCM and non-PCM groups (Table 1). PCM was significantly more prevalent among hospitalizations with ALD or MASLD than those without ALD, MASLD, or neither (ALD
: 175.5 vs. 51.7; MASLD: 69.2 vs. 52.9; neither: 51.5 per 1000 hospitalizations; p< 0.001) (Figure 1). Among hospitalizations with ALD or MASLD, PCM was significantly associated with mortality (ALD: adjusted odds ratio [aOR] 1.85, 95% CI 1.79-1.91; MASLD: aOR 2.30, 95% CI 2.10-2.52), additional lengths of stay (ALD: 3.91, 95% CI 3.80-4.01; MASLD: 5.17, 95% CI 5.00-5.33), and total charges (ALD: $47k greater charges, 95% CI 45k-50k; MASLD: $60k greater charges, 95% CI 57k-64k) (Figure 1).

Discussion: Our study found an increased prevalence of PCM among those with ALD compared to MASLD and neither condition. Furthermore, PCM was associated with increased mortality, length of stay, and total charges in those with ALD and MASLD. This underscores the importance of early identification and management of PCM in patients with steatotic liver disease, especially those with ALD given the increased prevalence compared to MASLD in order to mitigate adverse clinical outcomes and reduce healthcare utilization.



Disclosures:


Sowon Kim, MD¹, Andrew Roney, MD², Alexandra C. Greb, MD², Berkeley Limketkai, MD, PhD², Po-Hung Chen, MD, PhD³. P4610 - Prevalence and Impact of Protein-Calorie Malnutrition in Hospitalized Patients With Alcohol-Associated Liver Disease or Metabolic Dysfunction-Associated Steatotic Liver Disease, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.