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.