Comparison of current practice and best practice guidelines for the nutritional management of patients with liver cirrhosis: An Australian survey of dietitians in clinical practice
Aim
Malnutrition is common in patients with chronic liver disease and is recognised as a prognostic factor with evidence suggesting that sufficient nutritional support can improve outcomes. However, malnutrition in this patient population continues to be underdiagnosed and managed in clinical practice. This paper outlines a study aimed to determine current practice among dietitians, compares this with best practice guidelines and identifies barriers to achieving best practice.

Methods
This study aims to involved an anonymous online survey questionnaire targeted at dietitians with at least 12 months of experience working with patients with liver cirrhosis.

Results
A total of 41 completed surveys were received and analysed. Results showed that the majority (85%) of respondents were using the European Society of Clinical Nutrition and Metabolism guidelines. Over 85% of surveyed dietitians reported that they were currently recommending high-energy and high-protein diets to their patients. Methods used to calculate dietary requirements varied, with some respondents using actual weight and others using dry weight. There was also variation in nutrition assessment tool used among surveyed respondents. Thirty-six per cent of respondents reported that nasogastric feeding always or often commenced when recommended. The most commonly reported barrier to achieving best practice was patient compliance.

Conclusions
From the study, it appears that most dietitians are consistently recommending high-energy and protein intake. However, there is significant variation in practice for weights used in calculating nutritional requirements, assessing nutritional status and nasogastric tube use for nutrition support.