Objective: To ascertain whether current practice in teaching hospitals in New South Wales and the Australian Capital Territory delivers adequate dietary protein in the management of malnutrition in adults with cirrhosis, in accordance with European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines for nutrition in liver disease.
Main outcome measures: Current dietary protein prescription practice for patients with cirrhosis (with and without hepatic encephalopathy); use of nutritional supplements and enteral feeding for malnourished patients with cirrhosis.
Results: Dietitians following the ESPEN guidelines were in the minority: 36% of the dietitians recommended an adequate protein intake for patients with hepatic encephalopathy. Sixty-four per cent of the dietitians had received referrals from the medical team requesting inappropriate protein-restricted diets for patients without hepatic encephalopathy. Seventy-eight per cent of the dietitians requested clarification of the recommended nutritional management of patients with cirrhosis.
- 1. Donaghy A. Issues of malnutrition and bone disease in patients with cirrhosis. J Gastroenterol Hepatol 2002; 17: 462-466.
- 2. Sherlock S. Hepatic encephalopathy. In: Diseases of the liver and biliary system. 8th ed. Oxford: Blackwell Scientific Publications, 1989: 109-110.
- 3. Plauth M, Merli M, Kondrup J, et al. ESPEN guidelines for nutrition in liver disease and transplantation. Clin Nutr 1997; 16: 43-55.
- 4. Cordoba J, Lopez-Hellin J, Planas M, et al. Normal protein diet for episodic hepatic encephalopathy: results of a randomized study. J Hepatol 2004; 41: 38-43.
- 5. Nielsen K, Kondrup J, Martinsen L, et al. Long-term oral refeeding of patients with cirrhosis of the liver. Br J Nutr 1995; 74: 557-567.
- 6. Soulsby CT, Morgan MY. Dietary management of hepatic encephalopathy in cirrhotic patients: survey of current practice in the United Kingdom. BMJ 1999; 318: 1391.
- 7. Owen OE, Trapp VE, Reichard GA Jr, et al. Nature and quantity of fuels consumed in patients with alcoholic cirrhosis. J Clin Invest 1983; 72: 1821-1832.
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.