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Liver Diseases pp 569–586Cite as

Medical Nutrition Therapy in Liver Disease

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Abstract

It is acknowledged that acute or chronic hepatic pathology produces numerous changes to the entire metabolism, but also to the nutritional status. One essential feature is the presence of protein-caloric malnutrition in both acute and chronic hepatic diseases; and its presence is considered a significant risk factor for morbimortality. Importantly, the Nutritional Care Process, part of the medical nutritional intervention develops the tools for the identification, diagnosis, correction and monitoring of malnutrition, but also of its complications. Moreover, the nutritional intervention tackles each hepatic pathology in its either acute or chronic form, determines and implements the caloric requirements and even the composition of macro- and micronutrients necessary for the achievement of an optimal nutritional status, corrects nutritional deficiencies and improves the life quality of the patient with liver impairment.

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Author information

Authors and Affiliations

  1. Diabetes, Nutrition and Metabolic diseases Department, Faculty of Medicine, UMF “Carol Davila”, Bucharest, Romania

    Anca Pantea Stoian

  2. Internal Medicine Discipline—Gastroenterology Department, Faculty of Medicine, Ovidius University, Constanţa, Romania

    Andra Iulia Suceveanu & Adrian Paul Suceveanu

  3. Oncology Discipline, Faculty of Medicine, Ovidius University, Constanţa, Romania

    Laura Mazilu

  4. Internal Medicine—Cardiology Department, Faculty of Medicine, Ovidius University, Constanţa, Romania

    Irinel Raluca Parepa

Authors
  1. Anca Pantea Stoian
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  2. Andra Iulia Suceveanu
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  3. Adrian Paul Suceveanu
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  4. Laura Mazilu
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  5. Irinel Raluca Parepa
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Editor information

Editors and Affiliations

  1. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Florentina Radu-Ionita

  2. New Jersey Medical School, Rutgers University New Jersey Medical School, Newark, NJ, USA

    Nikolaos T. Pyrsopoulos

  3. Carol Davila University of Medicine and Pharmacy, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Mariana Jinga

  4. Faculty of Medicine, “Titu Maiorescu” University, Central Military Emergency University Hospital “Dr. Carol Davila”, Bucharest, Romania

    Ion C. Tintoiu

  5. Medical Radiation Sciences, Curtin University, Perth, WA, Australia

    Zhonghua Sun

  6. “Prof. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases, Bucharest, Romania

    Ecaterina Bontas

Self Study

Self Study

1.1 Questions

  1. 1.

    Concerning nutritional, medical intervention in acute liver disease, which of the following statements are false:

    1. (a)

      The daily calorie requirement for acute liver disease does not require significant adjustments.

    2. (b)

      The amount of protein must exceed 15% of the daily calorie requirement to prevent malnutrition.

    3. (c)

      The need for minerals and vitamins will be supplemented if their deficit is documented.

    4. (d)

      The nutritional attitude provides a caloric intake of 40–45 kcal/kg; the protein intake will be the normal recommended one of 15–17% up to 20% of the total caloric intake, the restriction is recommended in case of hepatic comas.

    Answer: b.

  2. 2.

    Concerning nutritional, medical intervention in chronic liver disease, which of the following statements are true:

    1. (a)

      Malnutrition can occur even from the early stages of the chronic liver disease, including NAFLD.

    2. (b)

      The severity of malnutrition is frequently associated with the presence of other complications such as hepatic, renal syndrome or encephalopathy in chronic liver disease.

    3. (c)

      The recommended amount of carbohydrates in NAFL or NASH is 40–55% of the recommended daily amount of energy, and they must come mostly from refined foods.

    4. (d)

      The recommended protein requirement in the patient’s cirrhotic diet should be between 1 and 1.2 g/protein/kg/day, and in patients with decompensated cirrhosis this may increase to 1.5 g/protein/kg/day with an additional BCAA 0.25 g/protein/kg/day.

    Answer: b, d.

1.2 Answers

  1. 1.

    About nutritional, medical intervention in acute liver disease, which of the following statements are false:

    • (b) CORRECT ANSWER: in the case of acute liver disease, malnutrition correction is not necessary because it is not yet installed. Therefore, protein supplementation is not recommended.

  2. 2.

    Concerning nutritional, medical intervention in chronic liver disease, which of the following statements are true:

    • (b) CORRECT ANSWER: In chronic liver disease, malnutrition is almost exclusively due to excessive activation of anabolic processes. Any complication that accompanies the underlying liver disease aggravates the status of malnutrition in the sense of increasing its severity. Particularly hepato-renal syndrome, encephalopathy presenting ascites or oesophageal varices are the factors that hurt protein-calorie malnutrition.

    • (d) CORRECT ANSWER: the recommended protein requirement in the patient’s cirrhotic diet should be between 1 and 1.2 g/protein/kg/day, and in patients with decompensated cirrhosis this may increase to 1.5 g/protein/kg/day with an additional BCAA 0.25 g/protein/kg/day.

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Stoian, A.P., Suceveanu, A.I., Suceveanu, A.P., Mazilu, L., Parepa, I.R. (2020). Medical Nutrition Therapy in Liver Disease. In: Radu-Ionita, F., Pyrsopoulos, N., Jinga, M., Tintoiu, I., Sun, Z., Bontas, E. (eds) Liver Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-24432-3_51

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  • DOI: https://doi.org/10.1007/978-3-030-24432-3_51

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-24431-6

  • Online ISBN: 978-3-030-24432-3

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