International Journal of Nursing Sciences · Feb 8, 2026

Association of dietary energy and protein intake with frailty among patients with cirrhosis and implications for nursing practice

By Li G, Wang Y, Wang K et al.

OBJECTIVES: This study aimed to examine the relationships among frailty, dietary energy intake, protein intake, and protein type in patients with cirrhosis. METHODS: This study enrolled 267 eligible patients with liver cirrhosis from a tertiary hospital in Shandong Province between April 2024 and July 2024. Participants were divided into three groups based on the Liver Frailty Index: non-frail group (n = 63), pre-frail group (n = 132), and frail group (n = 72). Patients were assessed using the following questionnaires and scales: the General Demographic Information Questionnaire, the Child-Pugh Score Scale, the Liver Frailty Index, the Food Frequency Questionnaire, the International Physical Activity Questionnaire-Short Form (IPAQ-SF), and the Patient Health Questionnaire-9 (PHQ-9) for depression. Multiple logistic regression was used to examine the associations between frailty and dietary energy intake, protein intake, and the animal-to-plant protein ratio. Receiver operating characteristic (ROC) curve analysis was employed to identify the optimal thresholds for energy, protein, and protein ratio to differentiate between non-frail and frail states. RESULTS: Based on the Liver Frailty Index, 63 patients (23.6 %) were classified as non-frail, 132 (49.4 %) as pre-frail, and 72 (27.0 %) as frail. The prevalence of frailty was significantly higher in females (37.0 %) than in males (22.6 %) (P < 0.05). Multivariable logistic regression analysis, after adjustment for potential confounders (including age, sex, education level, etiology, Child-Pugh class, physical activity, depressive symptoms, and polypharmacy), higher dietary energy (P = 0.044), total protein (P = 0.003), animal protein (P = 0.004), and a higher animal-to-plant protein ratio (P = 0.015) were associated with a lower risk of frailty. ROC curve analysis further identified the optimal thresholds for distinguishing frailty from non-frailty as 30 kcal/(kg·d) for energy intake, 0.83 kcal/(kg·d) for total protein intake, and 0.34 for the animal-to-plant protein ratio, respectively. When patients maintained their nutritional intake above these thresholds, their risk of frailty was significantly reduced. CONCLUSIONS: Increasing dietary energy and protein intake, particularly from animal sources, is associated with a reduced risk of frailty in cirrhosis patients. This suggests that in clinical nursing practice, guiding patients to appropriately increase their dietary energy and protein intake, particularly by optimizing the proportion of animal protein, may help reduce the risk of frailty.

doi.org/10.1016/j.ijnss.2026.02.001 Open access PubMed 41938001 Populations