Evaluation of a Nutrition Education Guide for Patients With Cirrhosis

The assessment of participants' nutritional knowledge was conducted using a questionnaire created by experts from the research team with the intent to be solely based on the chapters of the Guide. The questionnaire consists of 14 items related to nutritional recommendations (dietary intake, protein, sodium, etc.), as well as questions regarding nutritional choices in the context of cirrhosis, definitions of nutritional terms, food groups and nutrients.

Patients' quality of life was assessed using the Chronic Liver Disease Questionnaire (CLDQ), a validated tool specific for patients living with chronic liver disease. This questionnaire consists of 29 items categorized into 6 domains: abdominal symptoms, activity, emotional function, fatigue, systemic symptoms, and worry. Each domain is scored on a scale from 1 (indicating severe impact) to 7 (indicating minimal impact), with higher scores reflecting a lower frequency of symptoms and, therefore, an improved health-related QoL. The overall score is obtained by calculating the average of the 29 items.

The nutritional risk was evaluated using the Liver Disease Undernutrition Screening Tool (LDUST). The LDUST is an easy-to-use tool that allows patients to answer questions about the 6 components of the Malnutrition Identification Table, which is the consensus of the Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition.

Dietary intakes were assessed using a validated, web-based, self-administered 24h dietary recall (R24W) developed at Université Laval (Québec, Canada). Participants were invited by email to complete the R24W on 2 unannounced days (1 weekend day and 1 weekday) selected randomly by a computer algorithm over a 7-day period, at every data collection timepoint.

Three online focus groups were conducted between August 2022 and October 2024. To be eligible, participants had to be in the Guide+ group. Each focus group was of an average duration of one hour and included 2 to 4 patients along with a patient partner to ensure the patients felt at ease and to facilitate the discussion. Focus groups were conducted by the registered dietitian on the Zoom meetings platform. Discussions were semi-directed based on an interview Guide that was developed by the research team prior to sessions and approved by the ethics committee. The interview Guide covered various sections, namely patients' overall satisfaction, their opinion on the Guide's complexity and its daily applicability.