Nutritional habits in patients with chronic liver disease: adherence of real life diet to international guidelines and its association with disease stage

Nutritional habits in patients with HCV-related liver disease: real life experience compared to international guidelines and effect on disease progression Background and Aims In the presence of liver cirrhosis, the international nutrition guidelines recommend a daily intake of 35-40 or 25-35 Kcal/Kg in non-obese and obese patients, respectively. Daily protein intake should be of 1.2-1.5 gr/Kg and should be increased in the presence of sarcopenia. The aims of this study were to compare real-life cirrhotic patients nutritional habits to the international nutritional guidelines and to evaluate their role on liver disease progression. Methods We prospectively enrolled 34 patients with HCV-related liver cirrhosis without ascites (group C), 27 patients with HCV chronic hepatitis (group CH) and 22 healthy controls (group H), matched for age and gender. Nutritional intake was evaluated using a three-day food diary and elaborated through a software of the Italian Food Composition Database. Sarcopenia was evaluated on CT scan measuring the psoas muscle cross-sectional area. Cirrhosis progression was assessed by the difference of MELD score at baseline and after a 6 months follow-up (ΔMELD). Data are expressed as median value (25th-75th percentile). Results Daily pro-Kg intake significantly differed for: a) Kcal intake in the three groups C, HC and H [21.02 (18.66–28.68); 23.49 (17.21–29.23) and 26.97 (23.35–34.94); P=0.033, respectively]; b) proteins intake in the three groups C, HC and H [0.86 (0.71–1.10); 0.94 (0.79–1.12) and 1.06 (0.86–1.27); P=0.038, respectively]; c) Kcal intake of the obese patients of the group C (29%) compared to the non-obese [18.90 (14.37-23.49) vs 22.44 (20.19-31.00); P=0.032, respectively]; proteins intake of patients with severe sarcopenia (lower tertile) of the group C compared to the other patients of the same group [0.73 (0.66-0.81) vs 0.98 (0.71-1.20); P=0.010, respectively]. At linear regression, in the patients of group C, daily intake of soluble sugars was associated with ΔMELD (t 2.363, C.I. 0.002–0.039; P= 0.029), independently from age, gender, BMI and HCV viral load. Conclusions With respect to the nutritional guidelines, HCV cirrhotic patients: a) have a lower pro-KG daily intake of Kcal and proteins; b) when obese, respect caloric restriction; c) in the presence of sarcopenia, their proteins intake is too limited. Furthermore, a higher content in the diet of soluble sugars in associated with a more rapid disease progression in HCV cirrhotic patients.