EVALUATION OF A NUTRITIONAL EDUCATION GUIDE DESIGNED FOR PATIENTS LIVING WITH CIRRHOSIS: A RANDOMIZED CONTROLLED MIXED-METHODS STUDY.

Abstract

Background: Liver diseases are increasingly common in Canada, and patients with cirrhosis are at high risk for malnutrition due to difficulties in meeting energy and protein intake targets. This highlights the need for tailored nutritional interventions. This study evaluates the impact of the Nutrition in Cirrhosis guide on nutritional knowledge, quality of life (QoL), nutritional risk, and dietary intake, as well as patient satisfaction.

Methods: In this randomized controlled mixed-methods study, patients in the intervention group (Guide+) received and used the Guide for 6 months. Data was collected at baseline, 3 months and 6 months. Assessments included evaluation of nutritional knowledge (questionnaire based on the Guide), QoL (Chronic Liver Disease Questionnaire) and nutritional risk (Liver Disease Undernutrition Screening Tool). Satisfaction was evaluated with 3 focus groups including patients from the Guide+ group as well as a patient partner and thematic analysis was conducted.

Results: Thirty-nine patients were randomized into Guide+ (n=23) and Guide- (n=16) groups. The Guide+ group showed significantly greater improvement in nutritional knowledge (p=0.032) compared to Guide-. Knowledge scores increased from 74.3% at baseline to 84.0% after six months (p<0.001), while no significant change was observed in Guide- (p=0.143). Nutritional risk decreased significantly in Guide+ patients (47.8% to 21.7%, p=0.021) but remained unchanged in controls. No significant QoL changes were observed. Focus groups identified three main themes: navigational challenges, outcomes and feelings associated with the Guide.

Conclusion: The Nutrition in Cirrhosis guide effectively improved nutritional knowledge and reduced nutritional risk in cirrhosis patients. Patient feedback highlighted areas for improvement, affirming the guide's value in supporting nutritional education.