Nagaraja R Padaki, Kr Vinayakumar, Jyoti Mohapatra, Akash Roy, Abhishek Banerjee, Karan Kumar, Sourabh B Sonawale, Nandan Joshi
Overall, the findings indicate an increasing shift toward proactive nutritional management in CLD within Indian clinical practice, with routine screening commonly practiced, and 56.8% of clinicians reporting escalation of protein intake from 1.2 to 1.5 g/kg/day as disease severity progressed. BCAA supplementation was also considered, particularly in hepatic encephalopathy and advanced disease, to support muscle preservation and clinical outcomes.
BACKGROUND: Chronic liver disease (CLD) is increasingly prevalent in India and is frequently associated with malnutrition, sarcopenia, and hepatic encephalopathy (HE). Although national and international guidelines emphasize adequate nutrition and protein intake, real-world clinical practices in the Indian setting remain insufficiently characterized.
METHODS: A cross-sectional descriptive analysis comprising 12 questions was conducted using live polling and moderated discussions across six advisory board meetings over five months. A total of 57 gastroenterologists from across India participated. Discussions focused on compensated and decompensated cirrhosis and HE. Polling responses were analysed question-wise because participation varied across items.
RESULTS: Half of the clinicians assessed nutritional status every three months, while one-third relied on symptom-triggered evaluation. Lack of screening tools (39.6%) and limited awareness (29.2%) were major barriers to early diagnosis. Nutritional supplementation was primarily initiated based on sarcopenia (63.6%). High-protein supplements were recommended to at least half of CLD patients by most clinicians, with 37.2% prescribing them to 50-75% of patients. As disease severity progressed, 56.8% increased protein intake to ~1.5 g/kg/day. For protein intolerance, oral branched-chain amino acids (BCAAs) were preferred (51.2%). In HE, clinicians favoured maintaining protein intake with BCAA addition rather than restriction, and muscle preservation was the most recognized benefit (80%). In transplant candidates, a high-protein diet (~1.5 g/kg/day) with adjunct BCAA supplementation was prioritized. Poor taste, gastrointestinal intolerance, and cost were key adherence barriers.
CONCLUSION: Overall, the findings indicate an increasing shift toward proactive nutritional management in CLD within Indian clinical practice, with routine screening commonly practiced, and 56.8% of clinicians reporting escalation of protein intake from 1.2 to 1.5 g/kg/day as disease severity progressed. BCAA supplementation was also considered, particularly in hepatic encephalopathy and advanced disease, to support muscle preservation and clinical outcomes.