Nutritional issues in patients with obesity and cirrhosis

Abstract

Obesity and metabolic syndrome are considered as responsible for a condition known as the non-alcoholic fatty liver disease that goes from simple accumulation of triglycerides to hepatic inflammation and may progress to cirrhosis. Patients with obesity also have an increased risk of primary liver malignancies and increased body mass index is a predictor of decompensation of liver cirrhosis. Sarcopenic obesity confers a risk of physical impairment and disability that is significantly higher than the risk induced by each of the two conditions alone as it has been shown to be an independent risk factor for chronic liver disease in patients with obesity and a prognostic negative marker for the evolution of liver cirrhosis and the results of liver transplantation. Cirrhotic patients with obesity are at high risk for depletion of various fat-soluble, water-soluble vitamins and trace elements and should be supplemented appropriately. Diet, physical activity and protein intake should be carefully monitored in these fragile patients according to recent recommendations. Bariatric surgery is sporadically used in patients with morbid obesity and cirrhosis also in the setting of liver transplantation. The risk of sarcopenia, micronutrient status, and the recommended supplementation in patients with obesity and cirrhosis are discussed in this review. Furthermore, the indications and contraindications of bariatric surgery-induced weight loss in the cirrhotic patient with obesity are discussed.

Association between Sarcopenia and Depression in Patients with Chronic Liver Diseases

“…A previous Japanese study reported that in elderly functionally-independent and community-dwelling 1731 persons, sarcopenic obesity was closely linked to depression whereas either sarcopenia or obesity alone was not linked depression [47]. Sarcopenic obesity can be an adverse predictor for CLD patients [48]. While in our study, there were no sarcopenic obesity patients.…”

Molecular Mechanism Contributing to Malnutrition and Sarcopenia in Patients with Liver Cirrhosis

“…In patients with liver cirrhosis, the two most common symptoms related to taste are sweet taste aversion and salty taste intolerance, but also a metallic taste is frequently observed [ 79 ], whereby patients with hypozincemia report having either a dry mouth or a metallic taste [ 23 ]. The urinary loss of zinc is aggravated by the prevalent use of diuretics used to treat edema and ascites [ 80 ]. Meanwhile, medications used for oral treatment can also lead to taste alterations or even associated side effects, such as nausea and flatulence, consequently leading to appetite loss [ 52 ].…”

Oxygenic metabolism in nutritional obesity induced by olive oil. The influence of vitamin C

“…Investigations have demonstrated that the majority of human obesity cases with a nutritional etiology are produced by an excessive intake of lipids. [62][63][64][65][66][67] This model of overfeeding was formulated based on the use of "liquid diets", since this form of administration allows one to make dietary changes in a simple way and to know exactly the nutritional components of the diet. Thus, the diet administered to the control animals and that supplied to the overfed animals would only differ in the amount of energy ingested by the animals, with the difference provided only by the amount of lipids that they take in with the diet, maintaining the same proportion of the rest of the nutrients, vitamins and minerals and with the same nutritional quality.…”