Perception and knowledge about dietary intake in patients with liver cirrhosis and its relationship with the level of education

To determine patients perception and knowledge regarding diet in cirrhosis and its relationship with the level of patients education. Cross-sectional observational study. This study was conducted at Gastroenterology Outpatient Clinics at the Aga Khan University Hospital, Karachi, the Aga Khan Health Services, Malir, Karachi and Hamdard University, Karachi, from January to December 2010. Consecutive adult patients with compensated cirrhosis were enrolled. Demographic data, level of education, type and reason of food restriction as well as the source of dietary information was asked. Baseline laboratory test were performed, and nutritional status was assessed by BMI normogram. Ninety patients, 58% male were enrolled. Mean age of the patient was 49 +/- 11 years. Overall 73% of the patients were restricting fat, meat, fish and eggs in their diet; 53% were in uneducated group and 47% were in educated group [CI, 0.24-1.62, p-0.34]. Twenty two patients [62.8%] in uneducated and 21 in educated group [68%] were restricting diet on the advice of their doctors, whereas 13 in uneducated group [37%] and 11 in educated group [32%] believed these dietary components to be harmful for the liver. Thirty two of uneducated patient [71.1%] and 28 of educated patients [62.2%] believed that vegetables, fruits and sugarcane had a beneficial effect on the liver. Main source of dietary information to the patients was the doctor. On sub-group analysis those who restricted diet irrespective of their educational level, had more patients with BMI less than 18.5 kg/m[2], [CI 0.01-0.94, p-0.001], haemoglobin less than 12 g/dl [CI 0- 0.03, p-0.001] and serum albumin less than 3 g/dl [CI 0.1- 03, p-0.001]. Both educated and uneducated classes of the patients have improper knowledge and perception of diet in cirrhosis. Patients with cirrhosis who restricted diet, had relatively low BMI, haemoglobin and albumin as compared to those who did not restrict. Main source of dietary information to cirrhotic patients were health care personnels

Utility of P300 auditory event related potential in detecting cognitive dysfunction in patients with cirrhosis of the liver.

The P300 event related potential (P3ERP) latency has recently been advocated for detection of cognitive disturbances in early encephalopathy associated with chronic liver disease. The present study was undertaken to assess the magnitude of cognitive dysfunction, a marker of subclinical hepatic encephalopathy (SHE), in India, using this widely recommended test. One hundred and one patients with cirrhosis of the liver (17 females, 84 males; Age 43.3 +/- 11 years, 33 alcoholic, 49 viral induced, 19 cryptogenic) attending our tertiary care hospital were studied. P300 responses were elicited by the standard 'auditory odd ball paradigm'. A value of mean+2SD of the latency obtained in 40 age matched controls was established as a cut off to define latency prolongation in patients. The mean P3ERP latency of cirrhotics (363.6 +/- 32.1 msec) was significantly longer (p<0.05) than those of controls (347.8 +/- 24.8 msec). No difference was found in the latencies of cirrhotics with or without alcoholic aetiology of liver disease. 21 (20.8%) cirrhotics were found to have SHE i.e. latency prolongation beyond the cutoff value. A higher proportion of patients in advanced stage of liver disease had prolongation in latencies (p<0.02) compared to less severe cases. Till the time a gold standard is derived for detection of SHE, P3ERP latencies seem to be a reasonable method for detection as well as follow up of patients. Since SHE is considered as a preclinical stage of overt encephalopathy, it would be worthwhile screening cirrhotics for cognitive disturbances using P3ERP latencies and administering prompt therapeutic action.