Nutritional assessment and its clinical implications in a cohort of patients with hepatic fibrosis and advanced chronic liver disease

Background: Malnutrition is highly prevalent in patients with hepatic fibrosis and cirrhosis, and nutritional status plays a crucial role in chronic liver disease outcomes. Diets with poor nutrient quality and high reliance on ultra-processed foods (UPFs) may contribute to disease progression through metabolic and inflammatory pathways. Aims: To assess the nutritional status of patients with MASLD-related fibrosis and its association with fibrosis severity, evaluating body composition, dietary intake, dysfunctional eating behaviors and, in particular, UPF consumption. Nutritional changes after intervention were monitored during follow-up. Methods: This observational study included 41 outpatients with MASLD and significant fibrosis (F2–F4), followed at the Steatosis Outpatient Clinic of S. Orsola Hospital (Bologna). Liver stiffness (LSM) and steatosis (CAP) were measured using vibration-controlled transient elastography (FibroScan®). Biochemical, anthropometric and body composition (BIA) parameters were assessed at baseline and after a median 4-month follow-up. In cirrhotic patients, muscle strength and frailty were evaluated through handgrip dynamometry and Liver Frailty Index. Dietary intake was analyzed using a 7-day food diary processed with Handydiet® and compared with specific nutritional recommendations. UPF intake was assessed qualitatively through a UPF-focused FFQ and quantitatively from diary data according to the NOVA classification. Conclusions: MASLD patients with fibrosis showed multiple nutritional imbalances and high UPF consumption, which was significantly associated with more advanced fibrosis. Nutritional intervention led to improvements in anthropometric and body composition indicators. These findings highlight the need for early and structured nutritional management to support care and potentially slow liver disease progression.