Nutrition in Chronic Liver Disease

Abstract

Protein-calorie malnutrition is a transversal condition to all stages of chronic liver disease. Early recognition of micro or macronutrient deficiencies is essential, because the use of nutritional supplements reduces the risk of complications.The diet of patients with chronic liver disease is based on a standard diet with supplements addition as necessary. Restrictions may be harmful and should be individualized. Treatment management should aim to maintain an adequate protein and caloric intake and to correct nutrient deficiencies.The large majority of patients with grade I/II hepatic encephalopathy can tolerate a regular diet. Protein restriction can aggravate malnutrition and is not recommended, except in cases of hepatic encephalopathy unresponsive to optimized therapy.

Outcome and Nutritional Assessment of Chronic Liver Disease Patients Using Anthropometry and Subjective Global Assessment

“…PCM is considered an independent predictor of mortality and is associated with an increased number of complications such as variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome and an impaired liver regeneration capacity. Furthermore, CLD patients are more susceptible to fat-soluble vitamin and trace element deficiency, which also may lead to an impaired outcome (4,13,23) . Several factors contribute to malnutrition in patients with liver cirrhosis.…”

“…Several factors contribute to malnutrition in patients with liver cirrhosis. A reduction in food intake is caused by anorexia, nausea, Outcome and nutritional assessment of chronic liver disease patients using anthropometry and subjective global assessment Gonçalo NUNES 1 , Carla Adriana SANTOS 1 , Rita BAROSA 1 dysgeusia, early satiety (mainly when splenomegaly is present), heavy alcohol consumption, encephalopathy and the prescription of severely restrictive diets with low sodium content (4,8,13,19,23) . Impaired digestion and absorption occurs due to biliary salt deficiency, bacterial overgrowth and also portal hypertension that promote changes in the intestinal mucosa.…”

“…Impaired digestion and absorption occurs due to biliary salt deficiency, bacterial overgrowth and also portal hypertension that promote changes in the intestinal mucosa. High metabolic demands with an increase in rest energy expenditure are common in those patients, leading to increased malnutrition if an adequate calorie supply is not provided (4,8,13,19,23,27) . Nutritional assessment in CLD patients can be challenging.…”

“…Subjective Global Assessment (SGA) is a practical tool that combines data from clinical history and physical examination (weight loss, changes in dietary intake, gastrointestinal symptoms, functional capacity, metabolic demands, signs of muscle wasting and the presence of peripheral oedema) (7) . SGA is validated in cirrhotic patients, has been shown to predict prognosis and is highly reproducible (12,13,23) . Classic anthropometric parameters such as weight and Body Mass Index (BMI) are often overestimated by ascites and tissue oedema.…”

“…Skinfold thickness (bicep, triceps or subscapular) and mid upper arm circumference (MUAC) are less 226 • Arq Gastroenterol • 2017. v. 54 nº 3 Jul/Set influenced by patient fluid status and despite the possibility of inter-observer variability, these measures are considered to be more sensitive than BMI to detect malnutrition in CLD patients (13,20,26) . Laboratory parameters such as albumin and other serum proteins are unreliable as true nutritional status markers and its low serum concentration is associated with severity of liver disease and degree of inflammation (13,23) . Handgrip strength (dynamometry) is a very sensitive method to detect the functional impairment that reflects PCM and seems to be a good predictor of CLD complications (1,2,6) .…”