Nutritional Education Resource Developed for Patients Living With Cirrhosis: Impact of Hepatic Encephalopathy

Introduction: Liver disease affects 1 in 4 Canadians. One of the most common complications of chronic liver disease is malnutrition, which is associated with poor quality of life and prognosis. Nutritional education resources for this population are lacking. Purpose: The general objective is to assess the impact of the evidence-based Nutrition in Cirrhosis Guide on patients living with cirrhosis. Specifically, the aim is to assess malnutrition risk, nutritional knowledge and quality of life as well as the impact of history of hepatic encephalopathy (HE) on nutritional knowledge over 6 months. Methods: An on-going randomized controlled study including 100 patients with cirrhosis divided in 2 groups: Guide+ (n=50) and Guide- (n=50). All patients are assessed for malnutrition risk (Liver Disease Undernutrition Screening Tool), knowledge (questionnaire based on the Guide) and quality of life (Chronic Liver Disease Questionnaire) at baseline, 3 and 6 months. History of HE is collected. The Guide+ group of patients are provided with the Guide for 6 months and Guide- patients are not. Preliminary Results: To date, 23 patients have completed the study: Guide+ (n=11) and Guide- (n=12). Characteristics of participants are comparable at baseline. The preliminary results show a significant improvement of nutritional knowledge for Guide+ patients (from 76.2% at baseline to 84,4% after 6 months, P=0.016). The Guide- patients’ knowledge remained unchanged throughout the study. In the Guide+ group, 2 patients had a history of HE which did not lead to improvement of nutritional knowledge (from 82,0% at baseline to 77,0% after 6 months), whereas in patients without history of HE, improvement was observed (74,7% at baseline to 86,0% after 6 months). No significant changes were observed in quality of life and malnutrition risk. Conclusion: There is a significant improvement of patients’ nutritional knowledge following 6 months of using the Guide. However, preliminary results suggest that a history of HE could possibly impact their level of nutritional knowledge overtime. This denotes HE may play a role in learning new knowledge and patients with HE may require closer follow-up in regards to nutritional guidance.