A Systematic Review of Medical Nutrition Therapy Guidelines for Liver Cirrhosis: Do We Agree?

Abstract

Nutrition can play a significant role in the management of liver cirrhosis and its complications. However, adherence to the clinical practice guidelines (CPGs) is essential for the practice of evidence-based medicine and is considered as a health-quality indicator. A systematic search was conducted in scientific databases, and retrieved CPGs fulfilling the inclusion criteria were independently reviewed and appraised from 3 experienced researchers, based on the Appraisal of Guidelines for Research and Evaluation II instrument. A total of 13 relevant CPGs were retrieved, published by 7 associations/societies, focusing on the nutrition management (enteral nutrition and/or parenteral nutrition) on cirrhosis, decompensated cirrhosis, liver transplantation, and cirrhosis-related complications. Most CPGs scored low in the stakeholder, rigor of development, and applicability domains. Half of the CPGs recognized the need for counseling patients with cirrhosis on nutrition-related issues. Small meals spread throughout the day, including a late-night snack, were suggested, with protein intake ranging between 1.2 and 1.5g/kg of body weight. In ascites, Na restriction recommendation appeared unanimous. Several shortcomings and bias were recognized in cirrhosis-related medical nutrition therapy CPGs, indicating the need of improving CPG methodology.