Low 25(OH)Vitamin D levels are associated with nutritional risk and disease severity in outpatient individuals with advanced chronic liver disease

The aim of this cross-sectional study was to evaluate the association between serum 25-hydroxyvitamin D [25(OH)VitD], disease severity, nutritional and functional status in individuals with advanced chronic liver disease (ACLD). Clinical assessment included Child-Pugh, Model for End-Stage Liver Disease-Sodium (MELD-Na), and MELD 3.0 scores, as well as the presence of ascites. Nutritional status was assessed using disease-specific screening tools, anthropometry, body composition measures, including Dual-Energy X-ray Absorptiometry (DXA), sarcopenia and Liver Frailty Index (LFI). A total of 47 outpatients with ACLD were evaluated. 25(OH)VitD insufficiency (<30 ng/mL) prevalence was 76.6%. After multivariate adjustment, insufficiency was significantly associated with Child-Pugh B/C (OR = 8.247; p = 0.013), ascites (OR = 15.382; p = 0.016), and nutritional risk by RFH-NPT (OR = 13.168; p = 0.015). No independent associations were found with sarcopenia or frailty. Notably, ascites emerged as the pivotal link between clinical decompensation and nutritional vulnerability; its presence is a primary RFH-NPT criterion, which remained the only nutritional marker independently associated with vitamin D depletion. In conclusion, 25(OH)VitD insufficiency was associated with advanced disease severity and nutritional vulnerability. Patients at nutritional risk had 13.2 times higher odds of 25(OH)VitD insufficiency, while those with ascites and Child-Pugh B/C showed 15.4 and 8.2 times higher odds, respectively. These findings emphasise that 25(OH)VitD levels are more closely linked to early nutritional risk than to established sarcopenia and frailty in this population.