Dell Medical School, University of Texas at Austin, 1601 Trinity St., Building B, Austin, TX, 78712, USA.
Ascension Medical Group, 1601 Trinity St., Building B, Austin, TX, 78712, USA.
Dig Dis Sci. 2024 Sep;69(9):3226-3235. doi: 10.1007/s10620-024-08526-2. Epub 2024 Jun 28.
Malnutrition in cirrhosis is associated with poor outcomes, leading to guidelines for a high protein, low sodium diet; however, there is no guidance regarding the implementation of diet education in clinical practice.
A mixed methods study enrolled 21 patients with cirrhosis and their caregivers. Semi-structured interviews on barriers and facilitators of dietary education and adherence were conducted. Demographic and clinical data were obtained, along with quantitative measures of dietary adherence, including 24-h food recall and spot urine sodium. Combined deductive and inductive coding was used to identify qualitative themes, along with a quantitative assessment of interviews. Quantitative data was reported using descriptive statistics with frequencies, mean and confidence intervals.
Participants were mostly male (16/21) with a mean age 57.8 years (SE 2.8) and MELD-Na 9 (SE 1.2). 4 themes emerged: 1. More than 50% of participants and caregivers endorsed no or inadequate diet education 2. They reported mostly negative experiences with dietary adherence with largest impact on social life 3. Facilitators of adherence included the presence of household support and fear of complications of cirrhosis 4. Overwhelmingly desired non-generic handouts and information. Dietary adherence was poor with only one participant meeting protein and sodium requirements based on food recall. Four participants who adhered to < 2000 mg sodium had inadequate daily caloric intake.
Dietary education is inadequate, and adherence to dietary recommendations is poor in patients with cirrhosis. Future studies should use these barriers and facilitators for intervention development.
肝硬化患者营养不良与不良预后相关，因此指南建议肝硬化患者采用高蛋白、低钠饮食；然而，目前尚缺乏有关在临床实践中实施饮食教育的指导。
本混合方法研究纳入了 21 名肝硬化患者及其照护者。对饮食教育和依从性的障碍和促进因素进行了半结构化访谈。收集了人口统计学和临床数据，以及饮食依从性的定量测量结果，包括 24 小时食物回忆和即时尿钠。采用演绎和归纳相结合的编码方法来识别定性主题，并对访谈进行定量评估。定量数据采用描述性统计进行报告，包括频率、平均值和置信区间。
参与者主要为男性（21 名中的 16 名），平均年龄为 57.8 岁（标准差 2.8），MELD-Na 为 9（标准差 1.2）。有 4 个主题出现：1. 超过 50%的参与者和照护者表示没有接受或接受的饮食教育不足；2. 他们报告了大多数与饮食依从性相关的负面经历，对社会生活的影响最大；3. 依从性的促进因素包括家庭支持的存在和对肝硬化并发症的恐惧；4. 强烈希望获得非通用的讲义和信息。饮食依从性较差，只有 1 名参与者根据食物回忆满足蛋白质和钠的要求。4 名遵守 < 2000mg 钠的参与者每日热量摄入不足。
肝硬化患者的饮食教育不足，对饮食建议的依从性较差。未来的研究应利用这些障碍和促进因素来制定干预措施。
