Nutritional assessment in patients with chronic liver disease – Current accessibility and implementation

Abstract

Background and Aims

Poor body composition is associated with impaired outcomes in patients with chronic liver disease (CLD), and various assessment tools are used. The aim of this study is to gain insight into the clinical practice of nutritional assessment in patients with CLD.

Methods

A semi-structured online survey on nutritional assessment tools for measuring body composition in patients with CLD was conducted among hepatologists and dietitians, mainly from hospitals between April 2023 and May 2023.

Results

A total of 45 eligible surveys were included in this study (dieticians N=35, hepatologists N=10). All dieticians had at least one nutritional assessment tool available. Bio-electrical impedance and hand-grip strength were the most available and used. The most important reasons for assessment were diagnosis of nutritional status, evaluation of nutritional intervention and for assessing risk of mortality. A proportion of 49% of the dieticians and 60% of the hepatologists respectively were familiar with the ‘European society of parenteral and enteral nutrition Guideline Clinical Nutrition in Liver disease’. Only 13% of dieticians and 60% of the hepatologists knew the ‘European Association for the Study of the Liver Clinical Practice Guidelines on nutrition in chronic liver disease’ and only eight dieticians and one hepatologist used a protocol for nutritional assessment in patients with CLD.

Conclusion

The importance of measuring body composition in patients with CLD for diagnosing and monitoring nutritional status and for assessing risk of mortality is well-known by dieticians and most hepatologists. However, implementation of the current guidelines is substandard and should be improved.