ESPEN Practical Guideline: Clinical nutrition in liver disease

Bischoff, Stephan C.; Bernal, William; Dasarathy, Srinivasan; Merli, Manuela; Plank, Lindsay D.; Schütz, Tatjana; Plauth, Mathias; Peláez, Rosa Burgos; Irigoin, Robin Rivera

doi:10.20960/nh.03856

Cited by 17 publications

(25 citation statements)

References 248 publications

(353 reference statements)

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“…The liver is the central organ in the metabolism of nutrients, such as protein, fat, and carbohydrates. Chronic liver disease (CLD), which decreases liver functional reserves, is a major predisposing factor for malnutrition and sarcopenia, both of which increase the risk of liver‐related complications, such as infection, ascites, hepatic encephalopathy, and mortality 1–4 . Generally, malnutrition and sarcopenia can be reversed with nutritional counseling and interventions, such as optimal energy and protein intake, branched‐chain amino acid supplementation, and late evening snacks 5–7 .…”

Section: Introductionmentioning

confidence: 99%

“…The recommended assessment tools to evaluate malnutrition include muscle mass, dietary intake, subjective global assessment (SGA), and Royal Free Hospital‐global assessment (RFH‐GA) 1–3 . Although these nutritional assessment tools have good intra‐rater reliability and reproducibility, 2,9,10 CLD complications, such as ascites and edema, may impair the accuracy of clinical tools used to assess nutritional status and muscle mass.…”

Section: Introductionmentioning

confidence: 99%

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Usefulness of the Global Leadership Initiative on Malnutrition criteria to predict sarcopenia and mortality in patients with chronic liver disease

Miwa

Hanai

Nishimura

et al. 2022

Hepatology Research

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Aim The Global Leadership Initiative on Malnutrition (GLIM) criteria, a newly developed global consensus around core diagnostic criteria for malnutrition, needs validation studies for use in daily clinical settings. This study aimed to determine whether the GLIM criteria could predict sarcopenia and mortality in patients with chronic liver disease (CLD). Methods We retrospectively reviewed 858 patients with CLD who were treated at our hospital between March 2013 and December 2019. Sarcopenia was diagnosed based on the criteria proposed by the Japan Society of Hepatology. Malnutrition was assessed using the GLIM criteria, subjective global assessment (SGA), and Royal Free Hospital‐global assessment (RFH‐GA) and their predictive ability for sarcopenia and mortality were assessed using the logistic regression analysis and the Cox proportional hazards regression model, respectively. Results Among the eligible 406 patients, 67% were men, the median age was 74 years, and 26% had sarcopenia. The prevalence of malnutrition according to the GLIM criteria, SGA, and RFH‐GA was 21%, 35%, and 26%, respectively. Comparing malnourished with well‐nourished patients, the odds ratio for complicating sarcopenia was 2.54 (95% confidence interval [CI], 1.44–4.49) for the GLIM criteria, 2.13 (95% CI, 1.09–4.15) for the SGA, and 2.78 (95% CI, 1.56–4.95) for the RFH‐GA. During a median follow‐up period of 2.0 years, 176 (43%) patients died. After adjusting for confounding factors, the GLIM criteria could independently predict mortality (hazard ratio, 1.95; 95% CI, 1.37–2.81). Conclusions The GLIM criteria are useful in identifying sarcopenia and predicting mortality in patients with CLD.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Usefulness of the Global Leadership Initiative on Malnutrition criteria to predict sarcopenia and mortality in patients with chronic liver disease

Miwa

Hanai

Nishimura

et al. 2022

Hepatology Research

View full text Add to dashboard Cite

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“…In addition, carbohydrate-containing late evening snacks may improve the nutritional status of patients with cirrhosis. It is also recommended to evaluate and supplement micronutrient deficiencies in cirrhosis patients [153]. Further studies are required to assess the role of calorie intake in preventing infection.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…It is also recommended to evaluate and supplement micronutrient deficiencies in cirrhosis patients. 153 Further studies are required to assess the role of calorie intake in preventing infection.…”

Section: Nutrition In Cirrhosis To Prevent Infectionmentioning

confidence: 99%

Early Diagnosis and Prevention of Infections in Cirrhosis

et al. 2022

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Cirrhosis is a risk factor for infections. Majority of hospital admissions in patients with cirrhosis are due to infections. Sepsis is an immunological response to an infectious process that leads to end-organ dysfunction and death. Preventing infections may avoid the downstream complications and early diagnosis of infections may improve the outcomes. In this review, we discuss the pathogenesis, diagnosis, and biomarkers of infection, as well as incremental preventive strategies for infections and sepsis and consequent organ failures in cirrhosis. Strategies for primary prevention include reducing gut translocation by selective intestinal decontamination, avoiding unnecessary proton pump inhibitors’ use, appropriate use of beta-blockers and vaccinations for viral diseases, including coronavirus disease-2019. Secondary prevention includes early diagnosis and timely and judicious use of antibiotics to prevent organ dysfunction. Organ failure support constitutes tertiary intervention in cirrhosis. In conclusion, infections in cirrhosis are potentially preventable with appropriate care strategies to then enable to improve outcomes.

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“…Total parenteral nutrition should only be used if enteral nutrition is contraindicated [ 18 ]. It is important to note that parenteral nutrition has no clear advantage over enteral nutrition and may increase infectious complications [ 19 ].…”

Section: Dietary Modifications Before and After Liver Transplantationmentioning

confidence: 99%

Nutrition and Chronic Liver Disease

Fuente

2022

Clin Drug Investig

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Malnutrition is common in chronic liver diseases and worsens the patient’s prognosis. Many liver disorders are associated with nutritional deficiencies. Some of the main factors that can lead to malnutrition in patients with chronic liver disease include decreased lipid absorption and reduced albumin production. In addition, these patients are sometimes candidates for a liver transplant that requires nutritional intervention after surgery to improve their prognosis. Thus, it is very important to recognise malnutrition in patients with liver failure in order to resolve it, mainly by a complete history of the patient, dietary survey, determination of muscle mass and a subjective assessment. To ensure a good nutritional status, exercise and lifestyle changes are considered, including dietary modifications, especially with a Mediterranean pattern. This article reviews these topics, including dietary modifications before and after liver transplantation. Additionally, nutritional recommendations are offered to patients with metabolic hepatic steatosis.

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ESPEN Practical Guideline: Clinical nutrition in liver disease

Cited by 17 publications

References 248 publications

Usefulness of the Global Leadership Initiative on Malnutrition criteria to predict sarcopenia and mortality in patients with chronic liver disease

Usefulness of the Global Leadership Initiative on Malnutrition criteria to predict sarcopenia and mortality in patients with chronic liver disease

Early Diagnosis and Prevention of Infections in Cirrhosis

Nutrition and Chronic Liver Disease

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