HealthDay News — For patients who have hepatic cirrhosis or have undergone liver transplantation, medically ordered pre-procedural fasting times frequently exceed existing guidelines, according to a study published online January 13 in the Journal of Clinical Nursing.

Noting that protein and energy requirements are higher in patients with cirrhosis than in healthy individuals, Helen Vidot, from the Royal Prince Alfred Hospital in Camperdown, Australia, and colleagues examined the prevalence and duration of pre-procedural medically ordered fasting during a period of hospitalization. Participants included 34 patients who had hepatic cirrhosis or had undergone liver transplantation.

The researchers found that 97% of patients were malnourished. During the observation period, 65% of patients were fasting, with 43 fasting occasions and a median fasting time of 13.5 hours. On 40 occasions, fasting times exceeded the maximum 6 hour guideline recommended before the administration of anesthesia by the majority of anesthesiology societies. Seventy-seven percent of procedures requiring fasting occurred after midday. There was a 45% reduction in fasting time associated with eating breakfast on the day of the procedure.

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“Adherence to fasting guidelines and eating breakfast before the procedure can reduce fasting times significantly and avoid the potential induction of starvation metabolism in this nutritionally at risk group,” the authors write.


  1. Vidot H, Teevan K, Carey S, et al. A prospective audit of preprocedurial fasting practices on a transplant ward: when fasting becomes starving. J Clin Nurs. 2016; doi: 10.1111/jocn.13116