Assessment of Nutritional Status and Patient's Compliance with the Nutritional Guidelines in Chronic Hepatic Diseases, Ain Shams University Hospital

Abstract

Malnutrition in chronic hepatic patients is very common and usually leads to high morbidity and mortality. Nutritional status of the patients should be evaluated starting with a nutritional screening which is followed by a full assessment of at risk patients. There are several assessment tools can be used in chronic hepatic patients. Commonly used nutritional assessment tools include functional measurements, anthropometric methods, biochemical measurements, subjective global assessment and dietary assessment. Nutritional therapy should be based on the dietary recommendations to replace any deficiency related to energy, protein, lipids, carbohydrates, vitamins, and minerals.Dietary recommendations and guidelines for chronic hepatic patients were retrieved from the American Society of Parenteral and Enteral Nutrition (ASPEN) and European Society of Parenteral and Enteral Nutrition (ESPEN). Recommendation regarding energy requirements ranges from 25 to 40 kcal/ kg per day, while that regarding protein intake is 1.0-1.5 g/kg/day to avoid muscle wasting. The aim of this work was to assess the nutritional status of patients with chronic liver disease in Ain Shams university hospital, to identify the relationship between hepatic disease severity and severity of malnutrition and to measure the degree of patient’s compliance with the current international nutritional guidelines. An interview questionnaire was designed and applied on (161) chronic hepatic patients. The questionnaire includes dietary assessment, the PG-SGA and assessment of patient compliance to the current guidelines. Anthropometric assessment was carried out including weight, height, MAC and TSF. In addition, functional and biochemical assessment were carried out. Chronic hepatic disease severity was assessed by using Child-Pugh classification. In the current study, the majority of the patient suffered from hepatitis C infection (81.4%), followed by hepatitis B infection (8.1%).The majority of the studied chronic hepatic patients were males, illiterate, more than 45 years old Study results revealed that the highest percent of the studied chronic hepatic patients were graded as Child A, followed by Child B, while only small percent were graded as Child C.