Nutritional intake and diet quality over three years following liver transplantation

Recipients of liver transplantation (LT) are at high risk of malnutrition, sarcopenia and cardiovascular disease, yet no long-term dietary guideline after LT exists. This study aims to describe the nutritional intake and diet quality of LT recipients at 1-, 2-, and 3-years post-transplantation.

This cross-sectional study included adult patients with previous cirrhosis who underwent LT, divided into three cohorts: Cohort A (1-year post-LT), cohort B (2-years post-LT) and cohort C (3-years post-LT). Dietary intakes were assessed using the web-based 24 h dietary recall (R24W) and compared to the Acceptable Macronutrient Distribution Ranges (AMDR) and micronutrient reference values for the general population. Adherence to the Mediterranean diet and to the Canada's Food Guide were assessed using the Mediterranean (MED) score and the Healthy Eating Food Index (HEFI)-2019, respectively.

Sixty-two LT recipients (62.9 % male) were included in this study: Cohort A (n = 23), cohort B (n = 14) and cohort C (n = 25). No significant differences were found between cohorts A, B and C in terms of intake of energy (2436.0; 2097.5; 1847.0 kcal), protein (90.3; 75.2; 85.6 g), carbohydrate (267.6; 269.1; 227.4 g) and total fat (95.3; 74.9; 70.7 g), respectively. Total fat intake was at the upper limit of the AMDR across all cohorts. Compared to males, females showed lower adherence to the AMDR of carbohydrate and to the recommended intakes for iron and calcium (p = 0.036; 0.004; and 0.002; respectively). Fiber and vitamins A, D and E intakes were below recommended levels, while sodium exceeded the recommended level for both sexes. Adherence to the Mediterranean diet (score 18.0/44) and Canada's Food Guide (score 39.0/80) was relatively low.

Nutritional intakes and diet quality indices in LT recipient remained unchanged across the three years post-LT, with significant deficiencies in certain micronutrients. Macronutrients intake could be optimized to better meet the specific needs of this population. Tailored dietary guidelines are needed for LT recipients, after the early phase post-surgery.