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

Abstract

Patients with cirrhosis waiting for liver transplantation (LT) frequently present a nutritional disorder, which represents an independent predictor of morbidity and mortality before and after transplantation. Thus, a proper assessment of the food intake by using different methods, such as food records, food frequency questionnaires, and 24 h recall, should be deemed an important step of the nutritional management of these patients. The available published studies indicate that the daily food intake is inadequate in the majority of waitlisted patients. These findings were confirmed by our experience, showing that the daily intake of total calories, proteins and carbohydrates was inadequate in approximately 85-95% of patients, while that of lipids and simple carbohydrates was inadequate in almost 50% of them. These data highlight the need to implement an effective educational program provided by certified nutritionists or dieticians, who should work in close collaboration with the hepatologist to provide a nutritional intervention tailored to the individual patient requirements.

Keywords: caloric intake; cirrhosis; food records; liver transplantation; macronutrients intakes; malnutrition; patient adherence.

Figure 1

Degree of inadequacy for each macronutrient intake from the normal ranges indicated by international guidelines. The distribution of the degree of inadequacy from the range of normal intake is shown in the tertiles (n = 33). (a) Energy intake; (b) Complex carbohydrates intake; (c) Protein intake; (d) Simple carbohydrates intake; (e) Lipids intake. IR: inadequate reduced. IE: inadequate in excess.