Dietary protein intakes in patients with hepatic encephalopathy and cirrhosis: current practice in NSW and ACT

Abstract

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. STUDY DESIGN: Cross-sectional study of dietitians using a self-administered, mail-back survey. SETTING: Teaching hospitals in NSW and the ACT treating patients with cirrhosis. PARTICIPANTS: Dietitians seeing patients with cirrhosis in the 12 months prior to completing the survey. 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. CONCLUSION: Many medical and dietetic staff inappropriately restrict protein intake of patients with cirrhosis.