Malnutrition and Nutritional Support in Alcoholic Liver Disease: a Review

Chao, Andrew; Waitzberg, Dan Linetzky; Jesus, Rosângela Passos de; Bueno, Allain Amador; Kha, Victor; Allen, Karen; Kappus, Matthew R.; Medici, Valentina

doi:10.1007/s11894-016-0539-4

Cited by 22 publications

(16 citation statements)

References 82 publications

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“…In liver cirrhosis, several factors contribute to reduced oral intake including anorexia, decreased sense of smell and dysgeusia, nausea, abdominal pain and bloating. These may be worsened or even caused by micronutrient deficiencies such as zinc and magnesium [ 2 , 15 , 47 , 48 ]. The majority of cirrhotic patients unintentionally follow a low energy diet [ 49 ].…”

Section: Molecular Mechanisms Contributing To Disease-related Malnmentioning

confidence: 99%

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

Meyer

Bannert

Wiese

et al. 2020

IJMS

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Liver cirrhosis is frequently accompanied by disease-related malnutrition (DRM) and sarcopenia, defined as loss of skeletal muscle mass and function. DRM and sarcopenia often coexist in cirrhotic patients and are associated with increased morbidity and mortality. The clinical manifestation of both comorbidities are triggered by multifactorial mechanisms including reduced nutrient and energy intake caused by dietary restrictions, anorexia, neuroendocrine deregulation, olfactory and gustatory deficits. Maldigestion and malabsorption due to small intestinal bacterial overgrowth, pancreatic insufficiency or cholestasis may also contribute to DRM and sarcopenia. Decreased protein synthesis and increased protein degradation is the cornerstone mechanism to muscle loss, among others mediated by disease- and inflammation-mediated metabolic changes, hyperammonemia, increased myostatin and reduced human growth hormone. The concise pathophysiological mechanisms and interactions of DRM and sarcopenia in liver cirrhosis are not completely understood. Furthermore, most knowledge in this field are based on experimental models, but only few data in humans exist. This review summarizes known and proposed molecular mechanisms contributing to malnutrition and sarcopenia in liver cirrhosis and highlights remaining knowledge gaps. Since, in the prevention and treatment of DRM and sarcopenia in cirrhotic patients, more research is needed to identify potential biomarkers for diagnosis and development of targeted therapeutic strategies.

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Section: Molecular Mechanisms Contributing To Disease-related Malnmentioning

confidence: 99%

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

Meyer

Bannert

Wiese

et al. 2020

IJMS

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“…While all patients with chronic liver disease are at risk for depletion of various fat-soluble, water-soluble vitamins and trace elements, the most well-recognized micronutrient deficiencies related to alcohol overuse are vitamin B12 (cyanocobalamin), vitamin A, vitamin D, thiamine (B1), folate (B9), pyridoxine (B6), and zinc[ 114 , 115 ]. Following supplementation, when needed, an annual check-up once stable levels are achieved may be recommended[ 116 ].…”

Section: Micronutrient Status and Recommended Supplementation In Patimentioning

confidence: 99%

“…Following supplementation, when needed, an annual check-up once stable levels are achieved may be recommended[ 116 ]. Administration of B-complex vitamins such as thiamine, folate, and pyridoxine is needed to prevent Wernicke encephalopathy[ 114 ], Korsakoff’s syndrome, megaloblastic anaemia and neuropathies[ 116 ]. Moreover, and regardless of the etiology of cirrhosis, a consensus paper by the International Society for Hepatic Encephalopathy and Nitrogen Metabolism stated that since vitamin status is not easily assessed and since multivitamin supplementation is cheap and generally safe, use of short-term (2-wk course) oral vitamin supplements could be justified in patients with decompensated cirrhosis or at risk of malnutrition, and clinically apparent vitamin deficiencies should be treated specifically[ 117 ].…”

Section: Micronutrient Status and Recommended Supplementation In Patimentioning

confidence: 99%

Nutritional issues in patients with obesity and cirrhosis

Schiavo¹,

Busetto²,

Cesaretti³

et al. 2018

WJG

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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.

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“…However, proper diet alterations have been noted to not only prevent disease progression, but also to reduce the severity of liver failure [ 46 , 47 ]. The recommendation for malnourished patients with cirrhosis is 35–40 kcal/kg/day to promote anabolism [ 33 , 48 ]. Protein deficiency is a significant problem in malnutrition which can be addressed through an intake of 1.2–1.5 g/kg/day [ 48 , 49 ].…”

Section: Treatment Options For Malnourished Patientsmentioning

confidence: 99%

“…The recommendation for malnourished patients with cirrhosis is 35–40 kcal/kg/day to promote anabolism [ 33 , 48 ]. Protein deficiency is a significant problem in malnutrition which can be addressed through an intake of 1.2–1.5 g/kg/day [ 48 , 49 ]. Furthermore, hepatic damage causes an increase in aromatic amino acids (AAA) and decreases branched-chain amino acids (BCAA) which can lead to hepatic encephalopathy and other neurological complications [ 29 ].…”

Section: Treatment Options For Malnourished Patientsmentioning

confidence: 99%

Optimizing the Nutritional Support of Adult Patients in the Setting of Cirrhosis

Perumpail

Cholankeril

et al. 2017

Nutrients

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Aim: The aim of this work is to develop a pragmatic approach in the assessment and management strategies of patients with cirrhosis in order to optimize the outcomes in this patient population. Method: A systematic review of literature was conducted through 8 July 2017 on the PubMed Database looking for key terms, such as malnutrition, nutrition, assessment, treatment, and cirrhosis. Articles and studies looking at associations between nutrition and cirrhosis were reviewed. Results: An assessment of malnutrition should be conducted in two stages: the first, to identify patients at risk for malnutrition based on the severity of liver disease, and the second, to perform a complete multidisciplinary nutritional evaluation of these patients. Optimal management of malnutrition should focus on meeting recommended daily goals for caloric intake and inclusion of various nutrients in the diet. The nutritional goals should be pursued by encouraging and increasing oral intake or using other measures, such as oral supplementation, enteral nutrition, or parenteral nutrition. Conclusions: Although these strategies to improve nutritional support have been well established, current literature on the topic is limited in scope. Further research should be implemented to test if this enhanced approach is effective.

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Malnutrition and Nutritional Support in Alcoholic Liver Disease: a Review

Cited by 22 publications

References 82 publications

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

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

Nutritional issues in patients with obesity and cirrhosis

Optimizing the Nutritional Support of Adult Patients in the Setting of Cirrhosis

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