Adherence to Oral Nutritional Supplements After Being Discharged from the Hospital is Low but Improves Outcome in Patients with Advanced Chronic Liver Disease

Skladaný, Ľubomír; Vnenčaková, Janka; Lafférs, Lukáš; Skvarkova, Beata; Hrubá, Eva; Molcan, Pavol; Koller, Tomas

doi:10.2147/ppa.s283034

Cited by 11 publications

(7 citation statements)

References 54 publications

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“…In the first study, we focused on testing adherence to oral supplementation in patients with liver cirrhosis. 38 The sample consisted of patients with ACLD, the same as in this study. Adherence to oral supplementation decreased significantly after hospital discharge and was associated with worse outcomes.…”

Section: Discussionmentioning

confidence: 99%

The influence of prehabilitation in patients with liver cirrhosis before liver transplantation: a randomized clinical trial

SKLADANÝ,

LÍŠKA,

GURÍN

et al. 2024

Eur J Phys Rehabil Med

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BACKGROUND The high prevalence of liver cirrhosis in Slovakia leads to a great need for transplant treatment. The outcome of liver transplantation is influenced by several factors. AIM The main objective of this study is to test the effectiveness of prehabilitation compared to standard of care. DESIGN Prospective, double-arm, randomized, open-registry study. SETTING Patient in F. D. Roosevelt Teaching Hospital, Slovakia, Banská Bystrica. POPULATION The participants consisted of patients with liver cirrhosis (55 men, 25 women). METHODS The patients were randomized to the active prehabilitation group (N.=39) or the standard of care group (SOC) (N.=41). SOC represents the standard of care for patients prior to liver transplantation, consisting of a formal oral interview lasting 30 minutes. In addition to SOC, each patient with decompensated liver cirrhosis also underwent a prehabilitation intervention that included rehabilitation and nutrition support. Patients completed the exercises under the supervision of a physician during hospitalisation. RESULTS After one month, the liver frailty index improved in the prehabilitation group (P=0.05). No improvement in MELD (Model of End Stage Liver Disease) was found in the group that underwent the prehabilitation program (P=0.28), and no improvement was found in the Child–Pugh score after one month (P=0.13). In the prehabilitation groups compared with the SOC group, differences were not found in the MELD score (P=0.11). Better clinical outcomes according to the Child-Pugh score was found for the prehabilitation group compared with the SOC group (P=0.02). According to LFI, there was no difference between the groups (P=0.26). Very low adherence was found after three months. Only three patients in the SOC group and six patients in the prehabilitation group came to the check-up. Due to low adherence after 3 months in patients with liver cirrhosis, it is not possible to make an adequate comparison between groups after three months. CONCLUSIONS Despite the great effort to maintain adherence, it was not possible to draw a conclusion about the effectiveness of prehabilitation in patients before liver transplantation compared to standard of care because the main problem in Slovak patients with liver cirrhosis is low adherence. More studies are needed to identify the barriers that lead to low adherence in patients with liver cirrhosis. CLINICAL REHABILITATION IMPACT A promising result was found due to improvement of the Liver Frailty Index and the Child-Pugh Score after one month in the prehabilitation group.

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Section: Discussionmentioning

confidence: 99%

The influence of prehabilitation in patients with liver cirrhosis before liver transplantation: a randomized clinical trial

SKLADANÝ,

LÍŠKA,

GURÍN

et al. 2024

Eur J Phys Rehabil Med

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“…e observed differences in age, sex, and nutritional status between the groups reflected the differences in the natural history of the disease. In Central Europe with a high prevalence of cirrhosis [1,46], the median age of ALD cirrhosis at its diagnosis is usually in the mid-fifties [47,48]. In NAFLD cirrhosis, due to different pathogenetic factors, progression to cirrhosis appears to be slower [49].…”

Section: Discussionmentioning

confidence: 99%

Frailty in Nonalcoholic Fatty Liver Cirrhosis: A Comparison with Alcoholic Cirrhosis, Risk Patterns, and Impact on Prognosis

Skladaný

Molcan

Vnenčaková

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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Background. Physical frailty increases susceptibility to stressors and predicts adverse outcomes of cirrhosis. Data on disease course in different etiologies are scarce, so we aimed to compare the prevalence and risk factors of frailty and its impact on prognosis in nonalcoholic fatty liver (NAFLD) and alcoholic (ALD) cirrhosis. Patients and Methods. Cirrhosis registry RH7 operates since 2014 and includes hospitalized patients with decompensated cirrhosis, pre-LT evaluation, or curable hepatocellular carcinoma (HCC). From the RH7, we identified 280 ALD and 105 NAFLD patients with at least 6 months of follow-up. Results. Patients with NAFLD compared with ALD were older and had a higher proportion of females, higher body mass index (BMI) and mid-arm circumference (MAC), lower MELD score, CRP, and lower proportion of refractory ascites. The liver frailty index did not differ, and the prevalence of HCC was higher (17.1 vs. 6.8%, p = 0.002 ). Age, sex, serum albumin, and C-reactive protein (CRP) were independent predictors of frailty. In NAFLD, frailty was also associated with BMI and MAC and in ALD, with the MELD score. The Cox model adjusted for age, sex, MELD, CRP, HCC, and LFI showed that NAFLD patients had higher all-cause mortality (HR = 1.88 95% CI 1.32–2.67, p < 0.001 ) and were more sensitive to the increase in LFI (HR = 1.51, 95% CI 1.05–2.2). Conclusion. Patients with NAFLD cirrhosis had a comparable prevalence of frailty compared to ALD. Although prognostic indices showed less advanced disease, NAFLD patients were more sensitive to frailty, which reflected their higher overall disease burden and led to higher all-cause mortality.

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“…Rehospitalization rates for older adults are high and up to a third of readmissions are considered preventable [ 161 ]. Providing quality nutrition care upon and/or after discharge has been shown to reduce avoidable readmissions by 28% [ 161 ], due to the effect that nutrition intervention (predominately, prescription of ONS) has on oral intake and nutritional status [ 147 , 148 , 164 , 165 , 166 ]. Despite this, many older adults who are in need of quality nutrition care in this transition period do not receive it [ 167 ].…”

Section: Hospital-to-community Transitionmentioning

confidence: 99%

“…Communication problems between HCPs and across healthcare services, insufficient knowledge/attention to nutritional needs/problems by HCPs, and limited access to services have been described as barriers to delivering continuity of care [ 168 , 169 , 170 ]. Further complicating the problem is low compliance among those patients who do receive this care [ 153 , 164 ]. Qualitative and observational work has shown that gastrointestinal symptoms, lack of knowledge of ONS purpose, lack of ONS prescription and receiving nutrition care that lacked a person-centred approach are common reasons for low compliance among patients [ 153 , 171 ].…”

Section: Hospital-to-community Transitionmentioning

confidence: 99%

Identifying and Managing Malnutrition, Frailty and Sarcopenia in the Community: A Narrative Review

2021

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Malnutrition, frailty and sarcopenia are becoming increasingly prevalent among community-dwelling older adults; yet are often unidentified and untreated in community settings. There is an urgent need for community-based healthcare professionals (HCPs) from all disciplines, including medicine, nursing and allied health, to be aware of, and to be able to recognise and appropriately manage these conditions. This paper provides a comprehensive overview of malnutrition, frailty and sarcopenia in the community, including their definitions, prevalence, impacts and causes/risk factors; and guidance on how these conditions may be identified and managed by HCPs in the community. A detailed description of the care process, including screening and referral, assessment and diagnosis, intervention, and monitoring and evaluation, relevant to the community context, is also provided. Further research exploring the barriers/enablers to delivering high-quality nutrition care to older community-dwelling adults who are malnourished, frail or sarcopenic is recommended, to inform the development of specific guidance for HCPs in identifying and managing these conditions in the community.

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Adherence to Oral Nutritional Supplements After Being Discharged from the Hospital is Low but Improves Outcome in Patients with Advanced Chronic Liver Disease

Cited by 11 publications

References 54 publications

The influence of prehabilitation in patients with liver cirrhosis before liver transplantation: a randomized clinical trial

The influence of prehabilitation in patients with liver cirrhosis before liver transplantation: a randomized clinical trial

Frailty in Nonalcoholic Fatty Liver Cirrhosis: A Comparison with Alcoholic Cirrhosis, Risk Patterns, and Impact on Prognosis

Identifying and Managing Malnutrition, Frailty and Sarcopenia in the Community: A Narrative Review

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