Dysgeusia in MASLD-related Advanced Chronic Liver Disease (ACLD): a Silent Driver Towards the "Bermuda" Triangle of Malnutrition-sarcopenia-frailty Severely Affecting Prognosis

Overview

Journal Nutr J

Publisher Biomed Central

Date 2025 Jan 17

PMID 39819605

Authors

Marcello Dallio

Mario Romeo

Fiammetta Di Nardo

Carmine Napolitano

Paolo Vaia

Giorgia Iadanza

Simone Olivieri

Annachiara Coppola

Marco Niosi

Alessandro Federico

Affiliations

Soon will be listed here.

Abstract

Background: Dysgeusia is a distortion of the sense of taste whose prevalence and relationship with nutritional status in Metabolic dysfunction-associated Steatotic Liver Disease (MASLD)-related advanced chronic liver disease (ACLD) have never been systematically explored.

Methods: 200 MASLD patients [60 ≤ F3 fibrosis, 70 compensated ACLD (cACLD), and 70 decompensated (dACLD)] were enrolled. At baseline, the Child-Pugh (CP) score was determined. Dietary habits, body composition, and frailty were evaluated. The European Working Group (EWGSOP2) criteria defined sarcopenia. Dysgeusia was assessed by the Dysgeusia-Total-Score (DTS). A visual analog scale identified appetite impairment (VASAI). During a 6-month follow-up, liver-related decompensation events (LRDEs) were recorded.

Results: The prevalence of dysgeusia increased with the liver disease progression, appearing significantly higher in ACLD compared with ≤ F3 (65.7% vs 5%, p:0.003), as well as in dACLD compared to cACLD patients (58.5 vs 7.1% p < 0.0001). On 41 dACLD patients presenting dysgeusia, 37 (90.2%) showed a significant impairment of appetite levels. In dACLD, the CP score was positively correlated with both DTS (R:0.742) and VASAI (R:0.704), as well as DTS was directly correlated with VASAI (R:0.765) (all p < 0.0001). Compared with dACLD patients without dysgeusia, dysgeusia-affected dACLD patients presented a lower daily protein intake (g/kg/die) (1.55 ± 0.192 vs 1.34 ± 0.15, p < 0.0001). Sarcopenia (70.7 vs 41.3%) and frailty (69.29 vs 37.9%) were significantly more prevalent in dysgeusia-affected dACLD individuals (both p < 0.0001). These patients showed a higher risk of LRDEs occurrence during the follow-up [HR:2.205; C.I. 95%:1.186-4.099; p:0.01]. Logistic regression analysis revealed dysgeusia (aOR: 3.32), appetite impairment (aOR:1.32), sarcopenia (aOR: 3.75), and frailty (aOR:3.03) significantly associated with this outcome (all p < 0.0001).

Conclusions: Dysgeusia appears predominant in MASLD-dACLD and, via appetite impairment, in a close relationship with malnutrition, sarcopenia, and frailty, negatively influencing patients' outcomes.

References

Saunders J, Aasland O, Babor T, De la Fuente J, Grant M . Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption--II. Addiction. 1993; 88(6):791-804. DOI: 10.1111/j.1360-0443.1993.tb02093.x. View

Ishizu Y, Ishigami M, Honda T, Imai N, Ito T, Yamamoto K . Decreased appetite is associated with the presence of sarcopenia in patients with cirrhosis. Nutrition. 2022; 103-104:111807. DOI: 10.1016/j.nut.2022.111807. View

Caraceni P, Riggio O, Angeli P, Alessandria C, Neri S, Foschi F . Long-term albumin administration in decompensated cirrhosis (ANSWER): an open-label randomised trial. Lancet. 2018; 391(10138):2417-2429. DOI: 10.1016/S0140-6736(18)30840-7. View

Reiberger T, Hofer B . The Baveno VII concept of cirrhosis recompensation. Dig Liver Dis. 2023; 55(4):431-441. DOI: 10.1016/j.dld.2022.12.014. View

Zavaglia C, Brivio M, Losacco E, ONIDA L . [The dietary protein contribution and hepatic encephalopathy in cirrhosis]. Recenti Prog Med. 1992; 83(4):218-23. View

Lai J, Tandon P, Bernal W, Tapper E, Ekong U, Dasarathy S . Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021; 74(3):1611-1644. PMC: 9134787. DOI: 10.1002/hep.32049. View

Boursier J, Zarski J, de Ledinghen V, Rousselet M, Sturm N, Lebail B . Determination of reliability criteria for liver stiffness evaluation by transient elastography. Hepatology. 2012; 57(3):1182-91. DOI: 10.1002/hep.25993. View

Huang D, Noureddin N, Ajmera V, Amangurbanova M, Bettencourt R, Truong E . Type 2 diabetes, hepatic decompensation, and hepatocellular carcinoma in patients with non-alcoholic fatty liver disease: an individual participant-level data meta-analysis. Lancet Gastroenterol Hepatol. 2023; 8(9):829-836. PMC: 10812844. DOI: 10.1016/S2468-1253(23)00157-7. View

Yoshida D, Shimada H, Park H, Anan Y, Ito T, Harada A . Development of an equation for estimating appendicular skeletal muscle mass in Japanese older adults using bioelectrical impedance analysis. Geriatr Gerontol Int. 2014; 14(4):851-7. DOI: 10.1111/ggi.12177. View

10.

Villanueva C, Albillos A, Genesca J, Garcia-Pagan J, Calleja J, Aracil C . β blockers to prevent decompensation of cirrhosis in patients with clinically significant portal hypertension (PREDESCI): a randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 2019; 393(10181):1597-1608. DOI: 10.1016/S0140-6736(18)31875-0. View

11.

Eddowes P, Sasso M, Allison M, Tsochatzis E, Anstee Q, Sheridan D . Accuracy of FibroScan Controlled Attenuation Parameter and Liver Stiffness Measurement in Assessing Steatosis and Fibrosis in Patients With Nonalcoholic Fatty Liver Disease. Gastroenterology. 2019; 156(6):1717-1730. DOI: 10.1053/j.gastro.2019.01.042. View

12.

Shelley A, Horner K . Questionnaire surveys - sources of error and implications for design, reporting and appraisal. Br Dent J. 2021; 230(4):251-258. DOI: 10.1038/s41415-021-2654-3. View

13.

Plauth M, Bernal W, Dasarathy S, Merli M, Plank L, Schutz T . ESPEN guideline on clinical nutrition in liver disease. Clin Nutr. 2019; 38(2):485-521. PMC: 6686849. DOI: 10.1016/j.clnu.2018.12.022. View

14.

Eghtesad S, Poustchi H, Malekzadeh R . Malnutrition in liver cirrhosis:the influence of protein and sodium. Middle East J Dig Dis. 2014; 5(2):65-75. PMC: 3990138. View

15.

Kaps L, Lukac L, Michel M, Kremer W, Hilscher M, Gairing S . Liver Frailty Index for Prediction of Short-Term Rehospitalization in Patients with Liver Cirrhosis. Diagnostics (Basel). 2022; 12(5). PMC: 9139749. DOI: 10.3390/diagnostics12051069. View

16.

De Franchis R, Bosch J, Garcia-Tsao G, Reiberger T, Ripoll C . Baveno VII - Renewing consensus in portal hypertension. J Hepatol. 2022; 76(4):959-974. PMC: 11090185. DOI: 10.1016/j.jhep.2021.12.022. View

17.

DAmico G, Bernardi M, Angeli P . Towards a new definition of decompensated cirrhosis. J Hepatol. 2021; 76(1):202-207. DOI: 10.1016/j.jhep.2021.06.018. View

18.

Buchard B, Boirie Y, Cassagnes L, Lamblin G, Coilly A, Abergel A . Assessment of Malnutrition, Sarcopenia and Frailty in Patients with Cirrhosis: Which Tools Should We Use in Clinical Practice?. Nutrients. 2020; 12(1). PMC: 7020005. DOI: 10.3390/nu12010186. View

19.

Berzigotti A, Garcia-Tsao G, Bosch J, Grace N, Burroughs A, Morillas R . Obesity is an independent risk factor for clinical decompensation in patients with cirrhosis. Hepatology. 2011; 54(2):555-61. PMC: 3144991. DOI: 10.1002/hep.24418. View

20.

Russell R, Jacques P . Impairment of taste and olfaction in patients with cirrhosis: the role of vitamin A. Hum Nutr Clin Nutr. 1984; 38(3):203-14. View