Investigation of the effect of nutrition education on quality of life and nutritional status in patients with liver cirrhosis

Individuals with liver cirrhosis frequently experience various complications such as malnutrition. Providing information to patients about their medical conditions, the risk of malnutrition, and other complications of cirrhosis can help improve their nutritional status, increase their quality of life, and contribute positively to their overall health. This study was conducted to evaluate the effects of nutritional education on the quality of life, nutritional knowledge level, and nutritional status of individuals with liver cirrhosis. The study was conducted on a total of 30 volunteers, 21 male and 9 female, aged between 18 and 59 years, who were diagnosed with liver cirrhosis by a gastroenterologist between December 2021 and June 2024 at Ankara Bilkent City Hospital. The individuals participating in the study were first interviewed using a questionnaire form [general descriptive information, nutritional habits, physical activity status, anthropometric measurements (body weight, height, mid-upper arm circumference, triceps skinfold thickness), some biochemical findings, 24-hour food consumption record, Subjective Global Assessment (SGD) form, short-form-12 (SF-12) quality of life scale] and a nutritional knowledge level (BBD) form. Afterwards, a nutrition education (healthy nutrition and definition of food groups, recommendations regarding salt and water consumption, important steps of diet treatment in liver cirrhosis, food-drug interactions, food safety, label reading) was given to the individuals participating in the study. In the second interview one month later, the same nutrition education was repeated and a booklet-form education presentation was given. One month after the second education, the individuals were called by phone, reminded to read the education booklet, and their questions about nutrition were answered. In the last meeting, one month after the telephone interview, the questionnaire and BBD form applied at the beginning were repeated and the training was completed. At the end of the 3-month nutrition education, it was observed that the BBD score in all individuals increased from 7.4±2.76 to 9.2±3.45. A moderate positive correlation was observed between BBD and the dietary niacin, potassium, and phosphorus intake of individuals before the education. When the results of the SF-12 quality of life scale were examined, the physical component summary-12 (FBS-12) score of all individuals increased, while the mental component summary-12 (MBS-12) score decreased, but no significant difference was found. In all individuals, the number of those receiving SGD A score increased from 11 to 18; the number of those receiving SGD B score decreased from 16 to 11, and the number of those receiving SGD C score decreased from 3 to 1. After the nutrition education, the daily energy and protein intake per body weight in women decreased, while the daily protein intake per body weight in men increased from 0.7±0.56 g/kg to 0.8±0.40 g/kg. While the percentage of energy coming from fat increased in both genders, the daily amount of carbohydrates taken in the diet decreased in both genders. No significant change was observed in the amount of micronutrients taken in the diet. After the nutrition education, it was observed that the percentage of meeting the dietary reference intake (DRI) recommendations increased in women for vitamin A, riboflavin, folate, vitamin B6, vitamin B12, potassium, and calcium intakes; and in men for thiamine, riboflavin, folate, vitamin B6, vitamin B12, vitamin C, potassium, calcium, phosphorus, zinc, and magnesium intakes. When the salt consumption status of the individuals was evaluated; the number of individuals who preferred their meals with less salt increased from 16 to 20, the number of individuals who preferred normal salt decreased from 8 to 5, and 1 individual who preferred very salty changed their salt consumption status at the end of the training. When the distribution of the daily main meals consumed by the individuals was examined, the number of individuals who had three main meals increased from 18 to 20; the number of individuals who did not have snacks decreased from 11 to 6 in the distribution of snacks, while the number of individuals who had three snacks increased from 2 to 8. In terms of cooking methods, it was observed that the number of individuals who preferred the sautening method decreased from 16 to 10, and the number of individuals who preferred the frying method decreased from 7 to 3. While no significant change was observed in the anthropometric measurements of the individuals at the beginning and end of the training; it was observed that 60.0% of all individuals engaged in regular physical activity, and the most preferred activity was found to be walking. When the biochemical findings were examined; The mean serum aspartate aminotransferase (AST) level of women decreased from 93.7±129.93 U/L before training to 59.0±55.51 U/L after training, and the mean serum alanine aminotransferase (ALT) level of men decreased from 69.4±80.55 U/L before training to 49.3±35.79 U/L after training, and the mean serum ALT level of men decreased from 61.1±87.91 before training to 42.6±19.23 U/L after training. The mean gamma glutamyl transferase (GGT) level of women was 126.0±211.23 U/L before training and 106.8±157.82 U/L after training; The mean GGT levels of men before the training were found to be 76.0±78.88 U/L and 55.2±37.67 U/L after the training. The mean serum low-density lipoprotein cholesterol (LDL-C) levels of men decreased from 81.0±38.21 mg/dl before the training to 76.0±35.24 mg/dl after the training; while the mean high-density lipoprotein cholesterol (HDL-C) levels increased from 37.2±24.76 mg/dl to 47.2±26.65 mg/dl. In conclusion, it was observed that the nutritional education given to individuals with liver cirrhosis positively affected the individuals' nutritional habits and BBD scores. It is thought that longer training and follow-up periods will support the further increase of these effects.