Objectives To evaluate the quality of guidelines on nutrition in liver disease from 2017 to 2019, and to interpret these guidelines so as to provide references for clinical practice.Methods Computer-assisted literature searches in CNKI, VIP, WanFang Data, Medline (Ovid), The Cochrane Library, PubMed and Medlive databases were performed by two reviewers for guidelines on nutrition in liver disease from January 2017 to July 2019. Two reviewers extracted data and assessed the methodological quality of the included guidelines using AGREE II, separately. Meanwhile, the intraclass correlation coefficient (ICC) was used to assess the degree of consistency.Results Four guidelines were included with 2 from China and 2 from Europe. Their average standardised scores in the 6 domains of scope and purpose, stakeholder involvement, rigour of development, clarity, applicability and independence were 79.17%, 71.53%, 78.13%, 85.42%, 61.98% and 43.75%, respectively. The Chinese and European guidelines had similar recommendations for energy and other nutrients, apart from differences in recommendations for protein intake. The European guidelines considered that restricting protein intake was not beneficial for patients with hepatic encephalopathy, while the Chinese guidelines argued that patients with severe hepatic encephalopathy were required to reduce or limit their protein intake.Conclusions All 4 guidelines are of average quality and are required to be strengthened in the ‘independence’ domain. Currently, the only consensus on nutrition therapy for liver disease and guidelines on nutrition in end-stage liver disease are available for references in China, with lower quality scores than that of the European guidelines. Therefore, the evidence-based guidelines on nutrition in liver disease should be developed by Chinese national conditions as soon as possible to provide references for clinicians, nurses and clinical nutritionists, enableing them to implement nutrition screening, evaluation, nutritional therapy and follow-up management for patrents with liver disease.
Citation：
LIU Jing, QIAO Xinyao, SHI Lei, HU Wen. Quality evaluation and comparative interpretation of guidelines on nutrition in liver disease from 2017 to 2019. Chinese Journal of Evidence-Based Medicine, 2020, 20(9): 1083-1091. doi: 10.7507/1672-2531.201907044
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- 1. Vulcano DS, Carvalhaes MA, Bakonyi NA. Evaluation of nutritional indicators and body composition in patients with advanced liver disease enrolled for liver transplantation. Acta Cir Bras, 2013, 28(10): 733-739.
- 2. 北京医学会肠外肠内营养学专业委员会, 《慢性肝病患者肠外肠内营养支持与膳食干预专家共识》专家委员会. 慢性肝病患者肠外肠内营养支持与膳食干预专家共识. 中华临床营养杂志, 2017, 25(1): 1-11.
- 3. European Association for the Study of the Liver. EASL clinical practice guidelines on nutrition in chronic liver disease. J Hepatol, 2019, 70(1): 172-193.
- 4. Plauth M, Bernal W, Dasarathy S, <italic>et al</italic>. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr, 2019, 38(2): 485-521.
- 5. 中华医学会肝病学分会中华医学会消化病学分会. 终末期肝病临床营养指南. 临床肝胆病杂志, 2019, 35(6): 1222-1230.
- 6. Borhofen SM, Gerner C, Lehmann J, <italic>et al</italic>. The royal free hospital-nutritional prioritizing tool is an independent predictor of deterioration of liver function and survival in cirrhosis. Dig Dis Sci, 2016, 61(6): 1735-1743.
- 7. 许静涌, 康维明, 路潜. 营养风险及营养风险筛查工具营养风险筛查 2002 临床应用专家共识(2018 版). 中华临床营养杂志, 2018, 26(3): 131-135.
- 8. 杨瑗, 吴宇超, 齐晓丽, 等. RFH-NPT与 NRS-2002 在肝硬化住院患者营养风险评估中的应用比较. 陕西医学杂志, 2016, 45(12): 1661-1662.
- 9. Morgan MY, Madden AM, Soulsby CT, <italic>et al</italic>. Derivation and validation of a new global method for assessing nutritional status in patients with cirrhosis. Hepatology, 2006, 44(4): 823-835.
