Nutrition and liver disease: an evidence-based nutrition guide developed by experts in collaboration with cirrhotic patients
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According to a recent statement made by the Canadian Liver Foundation, 1 in 4 Canadians are affected by some degree of liver impairment. Liver cirrhosis is the final common pathway due to a variety of insults to the liver such as alcohol, virus and fat (obesity). Malnutrition is the most frequent yet treatable complication of cirrhosis. The causes of malnutrition in liver disease are multifactorial including reduced nutritional intake as well as altered macronutrient metabolism and malabsorption. Malnutrition causes loss of muscle mass which consequently leads to an increased risk of developing hepatic encephalopathy (serious neuropsychiatric complication of liver disease). Muscle mass loss is a strong independent predictor of morbidity and mortality in cirrhotic patients. Furthermore, malnourished cirrhotic patients have higher rates of infection, a higher prevalence of complications, and display longer hospitalizations. With such a clear association between poor nutritional status and negative medical outcomes, several consensus-based nutrition guidelines have been developed in order to inform clinical practice. However, the implementation of these guidelines into clinical practice has been a major clinical care gap for patients. The nutrition guidelines are not being properly met partly because of several barriers to achieving well-defined nutrition targets.
This session will detail the different steps of a dissemination initiative involving collaboration of medical experts (hepatologists, nutritionists, researchers) and patient volunteers in order to translate information regarding nutrition in liver disease into a home nutrition guide that is easy-to-use, has clear messages and is highly relevant for everyday situations at home. This dissemination project is intended to bridge the clinical gap between caregivers and patients and encourage patients to engage in their care and help them prioritize nutrition as a modifiable factor that can affect their health and quality of life.
Vanessa den Heyer, Presentation Description
Nutrition care of a cirrhotic patient is complex and diverse due to the unique needs and of an individual with cirrhosis. Consensus-based nutrition guidelines have been developed to inform the nutritional care of patients with cirrhosis; however, the implementation of these guidelines into practical patient centered education has been a gap for patients with cirrhosis.
It was the aim of this dissemination project to develop a nutrition education resource that offers accessible evidence based nutrition guidelines in a format that translates clinical nutrition guidelines into practical, simple to follow, and highly relevant instructions for a patient living with advanced cirrhosis.
Literature was initially reviewed with a focus on evaluating specific, and practical nutrition guidelines that may exist for cirrhosis. Following the literature review, dietitians supporting both inpatient and outpatient hepatology or transplant centers across Canada were surveyed in order to assess current RD practices, as well as collection of current resources being used in patient education. Simultaneously patient volunteers were recruited to participate in focus groups which was moderated by the dietitian to help bring gaps in patient education needs to light. Following these three information gathering processes, the team (researchers, physicians, and dietitian) was able to begin developing the resource. In order to fulfill the commitment of developing a patient advised tool that meets the needs of the end user, more patient volunteers were recruited to participate in a symposium which reviewed the content of the completed guide and provide valuable feedback and recommendations for revisions of the tool.
***Original Source: "2017 Annual Conference", Friday, May 26, 2017
Last Updated: June 26, 2017
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