Which clinical sign is a direct indicator of protein-energy malnutrition in chronic liver disease?

• A. Ascites
• B. Jaundice
• C. Varices
• D. Muscle wasting

Answer: (D)

Muscle wasting directly signals protein-energy malnutrition in chronic liver disease. When intake or utilization of protein and energy is inadequate, the body breaks down lean mass to meet its needs, leading to sarcopenia and visible loss of muscle. In liver disease, this loss reflects nutritional depletion rather than just liver-related complications.

The other signs point to liver dysfunction or portal hypertension rather than nutritional status. Ascites comes from fluid buildup due to low oncotic pressure and portal hypertension; jaundice arises from impaired bilirubin processing; varices are dilated vessels from portal hypertension. While these are important features of liver disease, they don’t specifically measure protein-energy stores.