Nutrition and Chronic Liver Disease

Abstract

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.

The regional disparities in liver disease comorbidity among elderly Chinese based on a health ecological model: the China Health and Retirement Longitudinal Study

“…In addition, both liver disease and gastric disease may be related to the imbalance of gut microbes, and these relationships reflect the physiological mechanism of the gut-liver axis [ 52 ], at the same time, long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of arthritis may lead to gastric mucosal damage, increase the risk of gastric ulcers, and likewise may be toxic to the liver and aggravate liver disease. It can be seen that the influencing factors of liver disease comorbidity involve not only individual traits and behaviors but also interpersonal networks, living and working conditions, and policy environments [ 53 – 57 ].…”

Association Between Pre-Transplant Oral Health and Post-Liver Transplant Complications

“…Our results showed significantly higher ALT levels and significantly lower albumin levels in patients with worse dental health. ALT is a highly liver-specific enzyme, and it being elevated in patients with worse oral health supports our hypothesis that untreated oral or dental inflammation might also influence the liver post-LT. Poor nutrition is shown to reduce albumin production [ 39 ]. In our study, worse oral health and fewer teeth were associated with lower albumin values.…”

From Listing to Recovery: A Review of Nutritional Status Assessment and Management in Liver Transplant Patients

“…The patients should receive about 1.5–2.0 g/kg of protein [ 38 , 143 ]; this protein intake recommendation is particularly relevant in the presence of fistulas or surgical drainage [ 161 ]. Therefore, adequate protein and energy intake provisions should be ensured during the acute post-LT phase to avoid protein breakdown, metabolic syndrome, and sarcopenia [ 161 , 162 ]. Hypermetabolism has been shown to predict transplant-free survival independently of MELD and Child–Pugh scores and tends to continue for at least one year post-LT [ 163 ].…”

“…During this time, energy is mainly generated by the oxidation of fatty acids [ 167 , 168 ]. After six hours, glucose administration could then be initiated [ 161 , 162 ], although it has been recommended in small doses and without insulin buffering to not suppress peripheral fat mobilisation, judged clinically by blood glucose levels, lactate, triglycerides, and arterial ketone bodies [ 167 , 168 , 169 ].…”

“…EN should only be stopped once patients maintain adequate oral intake consistent with their nutritional needs [ 131 , 170 , 171 ]. EN formulas should be enriched with protein, semi-elemental formulas with small peptides, and medium-chain triglycerides if malabsorption is present [ 161 , 162 ]. Regarding nutritional supplements nowadays, there is no clear evidence of their benefit after LT [ 164 ].…”