Background: Protein-calorie malnutrition (PCM) is a common problem in cirrhotic patients and is associated with increased morbidity and mortality. Diet plays a key role as a nutritional therapy in chronic liver disease. However, most cirrhotic patients have not received adequate nutrition counseling from their physicians and very few patients have access to a registered dietician.
Objective: To study effect of simplifying protein counting tool and educational intervention on the nutritional status in patient with cirrhosis.
Materials and Methods: An open-label, randomized clinical trial was conducted at GI clinic from October 2018 to February 2020. After a short period of nutrition counseling, participants were randomly assigned to the intervention group who received simplifying protein counting tool and the control group. The outcomes were nutritional status at 3 and 6 months: serum albumin, transferrin, Child-Turcotte-Pugh (CTP) score, MELD score, Patient-Generated Subjective Global Assessment score (PG-SGA), and protein counting skill.
Results: A total of 57 patients were enrolled. Of these, 18/30 (60%) of intervention group and 13/27 (48.2%) of control group had serum albumin improvement at 3 months. Protein counting skill achieved in 15 (50%) in the intervention group compared with 10 (37.0%) in the control group (p = 0.43). Patients who had achieved protein counting skill had statistically significant improvements in serum albumin (p<0.01), transferrin (p<0.01), CTP score (p<0.01) at 3 months and improvements in serum albumin (p<0.01), PG-SGA (p<0.01), CTP score (p<0.01), and MELD score (p<0.01) at 6 months.
Conclusion: Simplifying protein counting tool may improve protein counting skill. Nutrition advice may encourage the cirrhotic patient to have adequate protein intake to maintain a good nutritional status.

Keywords: Cirrhosis, Malnutrition, Protein counting tool