Cardiovascular disease and its concurrent risk factors are prevalent after liver transplant (LT). Most of these risk factors are modifiable by diet. We aimed to synthesise the literature reporting the nutritional intake of liver transplant recipients (LTR) and the potential determinants of intake. We performed a systematic review and meta-analyses of studies published up until July 2021 reporting the nutritional intake of LTR. The pooled daily mean intakes were recorded as 1998 (95% CI 1889, 2108) kcal, 17 (17, 18)% energy from protein, 49 (48, 51)% energy from carbohydrates, 34 (33, 35)% energy from total fat, 10 (7, 13)% energy from saturated fat, and 20 (18, 21) g of fibre. The average fruit and vegetable intake ranged from 105 to 418 g/day. The length of time post-LT and the age and sex of the cohorts, as well as the continent and year of publication of each study, were sources of heterogeneity. Nine studies investigated the potential determinants of intake, time post-LT, gender and immunosuppression medication, with inconclusive results. Energy and protein requirements were not met in the first month post-transplant. After this point, energy intake was significantly higher and remained stable over time, with a high fat intake and low intake of fibre, fruits and vegetables. This suggests that LTR consume a high-energy, low-quality diet in the long term and do not adhere to the dietary guidelines for cardiovascular disease prevention.

SARS-CoV-2 infection (COVID-19) is associated with malnutrition risk in hospitalised individuals. COVID-19 and malnutrition studies in large European cohorts are limited, and post-discharge dietary characteristics are understudied. This study aimed to assess the rates of and risk factors for ≥10% weight loss in inpatients with COVID-19, and the need for post-discharge dietetic support and the General Practitioner (GP) prescription of oral nutritional supplements, during the first COVID-19 wave in a large teaching hospital in the UK. Hospitalised adult patients admitted between March and June 2020 with a confirmed COVID-19 diagnosis were included in this retrospective cohort study. Demographic, anthropometric, clinical, biochemical, and nutritional parameters associated with ≥10% weight loss and post-discharge characteristics were described. Logistic regression models were used to identify risk factors for ≥10% weight loss and post-discharge requirements for ongoing dietetic input and oral nutritional supplement prescription. From the total 288 patients analysed (40% females, 72 years median age), 19% lost ≥ 10% of their admission weight. The length of hospital stay was a significant risk factor for ≥10% weight loss in multivariable analysis (OR 1.22; 95% CI 1.08–1.38; p = 0.001). In addition, ≥10% weight loss was positively associated with higher admission weight and malnutrition screening scores, dysphagia, ICU admission, and artificial nutrition needs. The need for more than one dietetic input after discharge was associated with older age and ≥10% weight loss during admission. A large proportion of patients admitted to the hospital with COVID-19 experienced significant weight loss during admission. Longer hospital stay is a risk factor for ≥10% weight loss, independent of disease severity, reinforcing the importance of repeated malnutrition screening and timely referral to dietetics.

Introduction: Malnutrition is common in patients with spinal cord injuries (SCI). ¹ National guidelines ^{2 3} have set recommended standards for nutrition screening in patients with SCI. An unpublished audit to assess the use of the Spinal Nutrition Screening Tool (SNST) found that in 2009 the use was low. Methods: The present audit aimed to reassess the use of SNST and whether there had been any improvement since 2009. Ninety-three adults (mean age: 51.4 years, SD: 17.3, 17.2% female) with SCI (53.7% tetraplegia; 51.6% complete SCI) were audited in December 2011, on five in-patient wards. Data from individual patient notes were collected by two trained professionals (dietitian and nurse) using a standardised questionnaire. Results: Seventy-one (76.3%) sets of notes had a SNST form. Sixty-nine (74.2%) patients had their weight measured on admission, 49 (52.6%) had their height recorded, and 59 (63.4%) had their SNST fully completed. At the time of audit, 47.9% of patients were found to be at risk of undernutrition, 11.5% had a body mass index <20 kg/m ² , and 19.4% were found to have eaten less than half of their last meal. The current audit showed that the use of the SNST has improved significantly: 2009 vs 2011: ward A: 0% vs 73.3%, p<0.01; ward p: 0% vs 33.3%, p=0.01; ward G: 23.5% vs 77.3%, p<0.01; Ward D: 22% vs 52%, p=0.03; ward J: 47.6% vs 81.3%, p=0.01;] and in the NSIC overall: 24% vs 63.4%, [p<0.001]. Conclusion: The uptake of nutrition screening appears to have improved in the NSIC but with much still to be achieved. A nutrition steering group has been set up to monitor and evaluate the implementation of nutrition policy on a continuing basis. Competing interests: S Wong: None declared, L Spillman: None declared, J Doraikannu: None declared, A Graham: None declared, D Green: None declared, G Grimble: None declared, A Forbes grant/research support from: National Institute for Health and Research. References: 1. Wong S , et al. Eur J Clin Nutr 2011 . doi: 10.1038/ejcn.2011.209 2. NICE . Nutrition Support in Adults: Oral Nutrition Support, Enteral Tube Feeding And Parenteral Nutrition. NICE, 2006. 3. Royal College of Physicians. Chronic Spinal Cord Injury: Management of Patients in Acute Hospital Settings: National Guidelines . London: Royal College of Physicians, 2008.