Effect of a 12-week nutritional intervention in the food intake of patients on the waiting list for liver transplantation: A secondary analysis of a randomized controlled trial

Abstract

BackgroundInadequate food intake contributes to malnutrition in patients with cirrhosis on the waiting list for liver transplantation (LTx). ObjectiveTo evaluate food intake during 12 weeks of nutritional follow-up and assess factors independently associated with the difference between caloric and protein intake in LTx patients. MethodsA secondary analysis of data from a randomized controlled trial that evaluated the effects of HMB supplementation in patients on a liver transplant waiting list. Dietary guidelines for patients with cirrhosis were used to prescribe the nutritional plan (35kcal/kg; 1.5g/kg dry weight for protein) and to evaluate the nutritional goals (30kcal/kg; 1.2g/kg dry weight for protein). Food intake was assessed in six moments: Baseline, week 0(W0), week 2(W2), week 4(W4), week 8(W8), and week 12(W12). ResultsForty-seven patients (55.0±10.6y;72.3% male) were evaluated. Only 25.5% (n=12) of patients achieve nutritional goals at the end of the study. The mean energy intake in baseline was 1782±784kcal (27.6±13.2kcal/kg) without difference between times. The protein intake increased between week W0 [63.4±29.8g; 0.8(0.2-2.2g/kg)] and W8 [72.0±28.0g; 1.0(0.4–2.6g/kg); p=0.03; p=0.03, respectively]. The consumption of cholesterol, calcium, phosphorus, magnesium, iron, and niacin increased (p<0.05), as well as the consumption of the leguminous; roots and tubers; dairy; and meat, poultry, and fish groups through the time (p<0.05). The presence of ascites, patients nourished, frailty index classification, short physical performance battery score, systemic symptoms, and emotional function were independently associated with the caloric intake difference W12-Baseline (p<0.05). Diabetes mellitus, patients with moderately malnourishment, poor performance, fatigue, systemic symptoms, and emotional function were independently associated with the difference in protein intake between W12-Baseline (p<0.05). ConclusionPatients on the liver transplant waiting list showed slight food intake improvement during the follow-up, but few met nutritional guidelines. Various clinical and nutritional factors independently affected energy and protein intake from W12 to baseline.