O4 Impact of hepatic encephalopathy in advanced chronic liver disease on appetite and nutritional intake: an exploratory prospective observational UK study

<h3>Introduction</h3> Hepatic encephalopathy (HE) is one of the most debilitating manifestations of advanced chronic liver disease (advCLD). Individuals with CLD and HE are recommended to eat every 2–3 hours and aim for a high protein diet to minimise sarcopenia. However the debilitating symptoms associated with HE may impact appetite and nutritional intake and acceleration of sarcopenia. We investigated reported appetite, nutritional intake, frailty and sarcopenia in those with CLD, with and without HE. <h3>Methods</h3> Participants were recruited (2022–2023) into this prospective exploratory observational study from the outpatient liver unit, University Hospital Birmingham (UK). Participants completed baseline and follow-up assessments, to investigate the impact of HE. Nutritional intake was assessed through 24-hour food recall and 3-day food diaries. Appetite was assessed through Council on Nutrition Appetite Questionnaire (CNAQ) and Emotional Appetite Questionnaire (EMAQ). Sarcopenia, frailty and exercise capacity were assessed through upper-arm anthropometry, liver frailty index (LFI) and Duke Activity Status Index (DASI). The study was approved by Wales Research Ethics Committee 2 and Health Research Authority (REC reference: 21/WA/0216). <h3>Results</h3> Twenty participants with advanced CLD were recruited (median age 54.5 years; 70% male; 70% ArLD): 10 with HE and 10 without HE for comparison. Table 1 shows baseline participant characteristics. CNAQ scores were similar for both groups. 3-day food diaries showed median energy, protein, fat and carbohydrate intakes were similar for both groups. 24-hour recall showed participants with HE consumed almost double the amount of carbohydrate per day than those without HE (216 vs 119g; p=0.023). Patients with HE had a strong positive relationship between 24-hour recall carbohydrate intake and EMAQ negative (rS=0.661, p=0.038). As well as a strong positive relationship between 24-hour recall energy (rs=0.697, p=0.025), carbohydrate (rs=0.782, p=0.008) and fat intake (rs=0.697, p=0.025) with handgrip strength. For patients with HE there was a strong positive relationship between 24-hour recall energy intake and LFI (rs=0.632, p=0.050). Patients with HE had significantly lower DASI METs, implying poor aerobic exercise capacity (4.69 vs 8.97; p=0.043). Neither group achieved the daily recommended energy (25–35kcal/kg) or protein (1.5–2.0g/kg) targets. <h3>Discussion</h3> This explorative study highlights that patients with CLD and HE consume significantly more carbohydrate than those without HE, which appeared to be related to negative emotions and situations. This may also explain why they have a non-significantly higher weight, BMI and lower aerobic exercise capacity. Median daily protein/energy intake was below recommended targets and in patients with HE this correlated with physical frailty. <h3>References</h3> Vilstrup H, Amodio P, Bajaj J, Cordoba J, Ferenci P, Mullen KD, Weissenborn K, Wong P. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. <i>Hepatology</i>. 2014;<b>60</b>(2):715–35. doi: 10.1002/hep.27210. European Association for the Study of the Liver. ‘EASL Clinical Practice Guidelines on nutrition in chronic liver disease’. <i>Journal of Hepatology</i>. 2019;<b>70</b>(1):172–193. doi: 10.1016/j.jhep.2018.06.024. Bischoff SC, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, Plauth M. ESPEN practical guideline: Clinical nutrition in liver disease. <i>Clinical Nutrition</i>. 2020;<b>39</b>(12):3533–3562. doi: 10.1016/j.clnu.2020.09.001. Merli M, Giusto M, Lucidi C, Giannelli V, Pentassuglio I, Di Gregorio V, Lattanzi B, Riggio O. ‘Muscle depletion increases the risk of overt and minimal hepatic encephalopathy: results of a prospective study’. <i>Metabolic Brain Disease</i>. 2013;<b>28</b>:281–284. doi: 10.1007/s11011-012-9365-z. Towey J, Ngonadi C, Rajoriya N, Holt A, Greig C, Armstrong MJ. ‘Protocol for a case-control prospective study to investigate the impact of Hepatic Encephalopathy on Nutritional Intake and Sarcopenia status in patients with end-stage LIVer disease: HENS-LIV study’. <i>BMJ Open Gastroenterology</i>. 2022:<b>9</b>(1). doi: 10.1136/bmjgast-2022-001052.