EASL Clinical Practice Guidelines on nutrition in chronic liver disease

Abstract

A frequent complication in liver cirrhosis is malnutrition, which is associated with the progression of liver failure, and with a higher rate of complications including infections, hepatic encephalopathy and ascites. In recent years, the rising prevalence of obesity has led to an increase in the number of cirrhosis cases related to non-alcoholic steatohepatitis. Malnutrition, obesity and sarcopenic obesity may worsen the prognosis of patients with liver cirrhosis and lower their survival. Nutritional monitoring and intervention is therefore crucial in chronic liver disease. These Clinical Practice Guidelines review the present knowledge in the field of nutrition in chronic liver disease and promote further research on this topic. Screening, assessment and principles of nutritional management are examined, with recommendations provided in specific settings such as hepatic encephalopathy, cirrhotic patients with bone disease, patients undergoing liver surgery or transplantation and critically ill cirrhotic patients.

Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis

“…Frailty is a multi‐dimensional construct that represents the end‐manifestation of derangements of multiple physiologic systems leading to decreased physiologic reserve and increased vulnerability to health stressors . These three conditions are increasingly common among patients with cirrhosis, particularly in those with decompensated liver disease, and in fact relatively overlap (but not identical), and all contributing to physical deconditioning and increased mortality . The main components of frailty are sarcopenia and physical impairment, which result in a cumulative decline in physiologic reserve .…”

“…The main components of frailty are sarcopenia and physical impairment, which result in a cumulative decline in physiologic reserve . It has clearly been shown that in those with cirrhosis and with malnutrition/sarcopenia/frailty there is reduced quality of life and survival, increased rates of cirrhotic complications and infections and have worse outcomes following surgery and liver transplantation (LT) . The pathogenesis of these conditions is complex and multifactorial and is more than just simple reduction of protein and calorie intake .…”

“…Hyperammonemia appears to be the main driver of sarcopenia in cirrhosis through several molecular signalling pathways . Prompt diagnosis and correction of malnutrition/sarcopenia are very important, and have shown to improve the poor outcomes to variable extents . Nutritional counselling and management in malnourished patients with cirrhosis should be performed by a multidisciplinary team to be able to achieve adequate caloric/protein intake and to avoid hypomobility.…”

“…Nutritional counselling and management in malnourished patients with cirrhosis should be performed by a multidisciplinary team to be able to achieve adequate caloric/protein intake and to avoid hypomobility. Branched‐chained amino acids (BCAA) and vitamin supplementations are recommended for patients with advanced liver disease . Other and novel strategies to reverse sarcopenia are currently under investigation …”

Patterns of alcohol consumption and nutrition intake in patients with alcoholic liver disease and alcoholic pancreatitis in North Indian men

“…The anthropometric measurements were expressed as a percentage of normal values. For calculating dry body weight in patients with ALD (which was used for calculating body mass index [BMI]) with ascites, subtracting a percentage of weight based upon severity of ascites (mild, 5%; moderate, 10%; severe, 15%) was carried out, with an additional 5% subtracted if bilateral pedal edema was present …”