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Nutrition in Chronic Liver Disease

  • Nutrition and Obesity (O Pickett-Blakely, Section Editor)
  • Published:
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Abstract

Purpose of review

Malnutrition is a common finding in patients with chronic advanced liver disease (CLD) and is an important prognostic predictor for morbidity and mortality. This review aims to summarize the latest evidence-based guidelines and expert opinion regarding diagnosing malnutrition in patients with CLD and providing optimal solutions.

Recent findings

In addition to diet, evidence demonstrates sarcopenia and frailty are emerging concepts critical to outcomes in those with CLD. Thus, adequate assessment of nutritional status incorporates the interplay of nutrient intake, sarcopenia, and frailty.

Summary

Addressing malnutrition in patients with CLD requires understanding the multifactorial mechanisms contributing to nutritional deficiencies, but also careful assessment of functional capacity. Interventions mitigating or reversing sarcopenia and frailty are equally important to nutritional supplementation. While the latency period between compensated and decompensated cirrhosis provides a good window for fruitful interventions, we believe providers need to be vigilant early on the course of CLD to maximize nutritional gains and halt muscle loss.

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Abbreviations

ALD:

Alcoholic liver disease

ASMI:

Appendicular skeletal muscle index

BCAAs:

Branch chain amino acids

BIA:

Bioelectrical impedance analysis

BMI:

Body mass index

CLD:

Chronic liver disease

CT:

Computed tomography

DEXA:

Dual energy X-ray absorptiometry

DM:

Diabetes mellitus

EASL:

European Association for the Study of the Liver

EN:

Enteral nutrition

HBA1c:

Glycosylated hemoglobin

HCC:

Hepatocellular carcinoma

HE:

Hepatic encephalopathy

HMB:

β-Hydroxy β-methylbutyrate

LVP:

Large-volume paracentesis

MAMC:

Mid-arm muscle circumference

MELD:

Model for end-stage liver disease

MRI:

Magnetic resonance imaging

mTOR:

Mammalian target of rapamycin

NAFLD:

Non-alcoholic fatty liver disease

NASH:

Non-alcoholic steatohepatitis

NEAT:

Non-exercise activity thermogenesis

PN:

Parenteral nutrition

REE:

Resting energy expenditure

SBP:

Spontaneous bacterial peritonitis

SIBO:

Small intestinal bacterial overgrowth

SMI:

Skeletal muscle index

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

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Authors and Affiliations

  1. Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA

    Yala Kirthi Reddy

  2. Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA

    Benedict Maliakkal & Uchenna Agbim

  3. Methodist Transplant Institute, Methodist University Hospital, 1211 Union Ave Suite 340, Memphis, TN, 38104, USA

    Benedict Maliakkal & Uchenna Agbim

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Reddy, Y.K., Maliakkal, B. & Agbim, U. Nutrition in Chronic Liver Disease. Curr Treat Options Gastro 17, 602–618 (2019). https://doi.org/10.1007/s11938-019-00252-3

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  • DOI: https://doi.org/10.1007/s11938-019-00252-3

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