S749 Vitamin A and Zinc Deficiencies Correlate With More Progressive Disease in Veterans With Advanced Liver Disease

Introduction: Patients with advanced liver disease (ALD) should be assessed for vitamin and micronutrient deficiencies as malnutrition and sarcopenia are associated with mortality, worse outcomes with transplant, and overall complications. The 2021 American Association for the Study of Liver Diseases (AASLD) guidelines recommend at least annual screening, with more frequent checks in decompensated disease. There is minimal research on the degree of nutritional deficiencies and targets for supplementation. Our study aims to identify correlations between the presence of certain deficiencies and the severity of liver disease. Methods: This is a single center, retrospective study evaluating vitamin and micronutrient deficiencies in Veterans with ALD seen at the Atlanta Veterans Affairs Liver Clinics from November 1, 2022 to October 31, 2024. Patients older than 18 years old, with a diagnosis of cirrhosis or advanced fibrosis, and at least 3 vitamins or micronutrients of interest checked within 12 months of the clinic visit, were included. Demographic data and liver disease history were obtained, along with levels of vitamin A, D, E, K, B1, B6, B9, B12, and C; zinc, selenium, copper, and iron. Statistical analysis was performed using Chi-square tests and T-tests, as appropriate. Results: Of 106 patients included, the average age was 64 years old, and 51% had a BMI greater than 30. The most common deficiencies were vitamins A (47%), D (50%), C (26.8%), and zinc (28%). A higher Model for End-Stage Liver Disease (MELD) 3.0 score correlated with deficiencies in vitamins A, E, B1, zinc, selenium, and iron. Patients with vitamins A, B1, B9 and zinc deficiencies were more likely to have had a hospitalization in the past 12 months related to cirrhosis. Similarly, vitamins A, E, B9 and zinc deficiencies were significantly associated with decompensated cirrhosis. Conclusion: Vitamin A and zinc deficiencies were associated with higher MELD 3.0 score, higher Child-Pugh score, recent hospitalization linked to cirrhosis, decompensation, clinically significant portal hypertension, ascites, history of large volume paracentesis, diuretic use, and higher grade esophageal varices. While vitamin D deficiency was very common, there were no significant correlations with cirrhosis features or decompensation markers. Our study highlights the importance of screening for vitamin and micronutrient deficiencies. In particular, vitamin A and zinc may play key roles in end stage liver disease. Further studies are needed to determine longitudinal outcomes with supplementation.