Micronutrient deficiencies in ambulatory adults with cirrhosis

Despite the well-established relationship between micronutrient deficiencies and cirrhosis, little is known of micronutrient deficiencies among ambulatory patients with cirrhosis awaiting liver transplant (LT). We aimed to characterize micronutrient deficiencies among patients with cirrhosis awaiting LT and assess their association with frailty, a complication with high morbidity and mortality.

Ambulatory adult patients with cirrhosis awaiting LT from June 2024 to March 2025 were tested for micronutrient deficiencies in clinical practice. Multivariable modeling was used to assess the association between frailty and micronutrient deficiencies.

Of 275 patients, the median (IQR) age was 60 (51-66) years and 114 (42%) were women. Median MELD 3.0 (IQR) was 17 (12-22), and 64 (23%) were frail. Micronutrient deficiencies were common, especially of zinc, vitamin D/E/B12, and selenium. Compared to patients who were not frail, frail patients were more likely to have vitamin B12 deficiency (34% vs. 18%, p=0.01), vitamin E deficiency (36% vs. 20%, p=0.02), and selenium deficiency (28% vs. 13%, p=0.01). Patients with vitamin B12, vitamin E, or selenium deficiency had 2.56 (95% CI: 1.04-6.20), 2.55 (95% CI: 1.06-6.11), and 3.00 (95% CI: 1.15-7.68) increased odds of frailty on univariable analysis. When controlling for confounders, selenium deficiency alone remained independently associated with frailty (adjusted OR: 2.55, 95% CI: 1.18-5.54, p=0.02).

Deficiencies of zinc, vitamin A/D/E/B12, and selenium are common in patients with cirrhosis awaiting LT and may represent a pragmatic panel of micronutrients to send in clinical practice. Selenium deficiency, in particular, was independently associated with frailty. Future studies should assess micronutrient repletion as a possible therapy in the multipronged approach to reversing frailty in patients with cirrhosis, as in the general population.