Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, Chair; Kathy Shadle James, PhD, RN; Tarek Hassanein, MD


Cirrhosis, Liver Disease, malnutrition, nursing, nutrition, outpatient assessment, patients


Cirrhosis is the 12th leading cause of death in the United States. It is well documented end stage liver disease drives a patient to a catabolic state thus depleting them of essential nutrients. Malnutrition is often unrecognized and untreated in outpatients. Though BMI, nutritional intake, anthropometric measurements have been used in clinical trials, there still remains no standard nutritional assessment. The purpose of this dissertation was to (1) identify the incidence of malnutrition in patients with compensated and decompensated liver disease utilizing defined nutritional parameters (Subjective Global Assessment, anthropometric measurements, hand grip strength, and laboratory values) and (2) correlate with care (hospital visits, physician appointments, outcome and quality of life) secondary to viral hepatitis, metabolic and alcoholic liver disease. The conceptual framework underlying this study is derived from the literature based on the domains of liver function, nutrition, and malnutrition. Nutrition includes the chemical substances in food utilized by the body for growth, maintenance, and repair: the intake, digestion, and assimilation and utilization of nutrients for tissue maintenance and energy provision. There is no gold standard for proper nutritional assessment of patients diagnosed with liver disease; notably, the traditional assessment tools are invalid with end-stage liver disease. Ascites, edema, and diuretics cause fluctuations in weight and weight changes. Cirrhosis of the liver drives a patient to a catabolic state, thus depriving them of essential nutrients. Simple and easily applied methods are needed to identify the patients approaching the state of malnutrition. Study findings presented in three papers provides a major contribution in discriminating the nutritional parameters of different etiologies of cirrhosis leading to malnutrition.

Document Type

Dissertation: Open Access



Included in

Nursing Commons