Low Adherence To Nutritional Recommendations In Patients With Cirrhosis: A Prospective Observational Study

Abstract

AIM:The aim of the study was to evaluate patients' adherence to the current nutritional recommendations adapted to the individual clinical status. MATERIALS AND METHODS: 192 outpatients with cirrhosis were prospectively evaluated. 161 were considered at risk of impaired nutrition as they present at least one of the following factors: altered body mass index score, non-volitional body weight changes, ascites, peripheral edema, hepatic encephalopathy, or diabetes.Patients at risk were offered a nutritional assessment by a nutritionist, including a 3-days food diary and hand-grip strength (HGS) test. Only 78 patients returned the diaries properly filled in. RESULTS: The analysis of food diaries showed a low-level adherence to the nutritional recommendations: caloric intake was insufficient, in excess or adequate in 75%, 13% and 12% of cases, respectively. An appropriate consumption of carbohydrates, protein and fibers was found only in 10-15% of cases, while the intake of simple sugars, lipids, and water resulted adequate in up to 55%. The protein intake was more frequently insufficient in patients with more advanced disease. HGS test was altered in 49% of patients. 27 subjects (17%) refused the nutritional assessment: these patients presented a significantly less severe disease and a lower number of risk factors. CONCLUSIONS: Patients with cirrhosis have inadequate nutritional intake and poor adherence to the recommendations provided during the normal path of care. Therefore, a multidisciplinary approach with a nutritionist should be recommended, starting in the early stage of the disease when the awareness of patients regarding the importance of nutrition appears to be lower.

Nutritional status in patients with chronic pancreatitis and liver cirrhosis is related to disease conditions and not dietary habits

“…Dietary habits of patients may have changed due to the disease or deteriorated nutritional status. However, studies have shown that habitual diet in general is largely stable for at least 5 years 53 , 54 and many patients with CP or LC fail to adhere to disease-specific dietary recommendations 55 , 56 . Moreover, in CP and LC other mechanisms such as an increased resting energy expenditure due to systemic inflammation or malabsorption can contribute to impaired nutritional status.…”

Identifying opportunities for hepatic encephalopathy self-management: A mixed methods systematic review and synthesis

“…A total of 16 quantitative studies (40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55) were retrieved (cohort, n = 12; case-control, n = 3; randomized controlled trial, n = 1) with the most common topic being knowledge assessment of patients (41)(42)(43)48,52,55), care partners (48), or physicians (45,49). Several studies, mostly from North America and Europe, also evaluated HE medication adherence of the patients (40,44,47,51,54)…”

“…Adherence to cirrhosis specific nutrition guidelines is consistently low across studies. In 78 patients (HE, 23%) where 80% were at risk of malnutrition, only 12% and 9% met their daily protein and calorie intakes, respectively (50). In an Indian study of 251 patients (mean MELD-Na 17.2), 16% ate a late evening snack and only 21% ate more than three meals or snacks per day (53).…”

“…The authors indicated that inadequate dietary advice was prevalent in their experiences and drew attention to similarities seen in a 1999 UK survey (49). In the exercise study that met our inclusion criteria, only 28% of 78 patients engaged in regular daily physical activity (50). The remainder led otherwise sedentary lives.…”

The Analysis of Food Intake in Patients with Cirrhosis Waiting for Liver Transplantation: A Neglected Step in the Nutritional Assessment

“…We have recently performed an observational prospective study specifically designed to assess the food intake in a cohort of outpatients with cirrhosis at different stages of severity [34]. The Emilia-Romagna ethic committee (CE-AVEC) reviewed and approved the study (number of approval 33/2014/U/Sper) and all patients gave informed consent before the inclusion.…”