Background: Prevalence of malnutrition in patients with cirrhosis has been reported to be high and it has major implications on morbidity and mortality in this group of patients. Malnutrition in cirrhosis still remains underdiagnosed and undertreated in routine clinical practice.
Aims: 1) to perform nutritional assessment of patients with compensated cirrhosis using validated tools. 2) to evaluate the effect of a personalised dietary intervention on the nutritional status of patients.
Methods: the Research Nurse will identify malnourished patients from a cohort of patients with Child-Pugh A cirrhosis using a combination of handgrip strength <30 Kg/F + Mid-arm muscle circumference (MAMC) <23cm and subjective global assessment tool. All patients will undergo anthropometric measurements, blood/urine biochemistry, chronic liver disease questionnaire (CLDQ) to evaluate quality of life and Dual Energy X-ray absorptiometry (DEXA) at baseline and 6 months following the intervention.
Participants: 21 patients with Child-Pugh A cirrhosis (based on histology or combination of clinical + non invasive markers) meeting the criteria of malnutrition.
Exclusions: Liver cancer, portal/splenic vein thrombosis, on-going alcohol abuse and uncontrolled diabetes.
Intervention: dieticians will evaluate individual’s nutritional requirements which will be used to develop a personalised dietary intervention. The effect of the intervention will be evaluated at 6 months follow-up.
Primary Outcome: improvement from baseline in the protein compartment and fat free mass on DEXA scan.
Secondary Outcomes: improvements in CLDQ, grip strength and MAMC post intervention; compliance with dietary intervention.
Results: We will describe the prevalence of malnutrition based on the parameters that are evaluated in the study cohort.
We will analyse the primary and secondary outcomes as the changes in the nutritional parameters assessed prior to and after 6 months of dietary intervention.
Conclusions: This nurse-led project will highlight the importance of a multi-disciplinary approach to liver care and the relevance of nutritional assessment and dietary interventions in this specific group of patients.
ACKNOWLEDGEMENTS
My sincere gratitude goes to the Florence Nightingale Foundation and NHS Professionals Ltd for supporting and funding part of this PhD project. I would also like to thank Nottingham University Hospitals Charity, the University of Nottingham and Nottingham University Hospitals Biomedical Research Unit, the University of Derby and Cambridge University Hospital Trust Clinical Research Facility.