Nutritional Implications in Chronic Liver Diseases

Abstract

Abbreviations: SGA, subjective global assessment; MI, maastricht index; NRI, nutritional risk index; BMI, body mass index; ESPEN, european society for parenteral and enteral nutrition; NT, nutritional therapy; BCAA, branched-chain amino acids; AAA, aromatic amino acids; MNTT, multiprofessional nutritional therapy team Mini reviewChronic liver disease-an inflammatory reaction in the liver of variable etiology and severity, with a progressive evolution characterized by the presence of fibrosis and alteration of the normal hepatic structure-presents with great nutritional impact, since the liver is the organ responsible for several biochemical pathways related to the production, modification and use of nutrients, among other important metabolic substances. 1Early stage liver disease may be asymptomatic or with nonspecific symptoms such as fatigue, anorexia/hyporexia, fever and malaise, easily confused with other diseases. As the disease progresses, hepatic insufficiency and portal hypertension may present with a symptomatic picture characterized by ascites, gastric/esophageal veins hemorrhage and hepatic encephalopathy. Chronic liver failure represents a continuous aggression to the hepatic parenchyma and has a multifactorial etiology, such as alcoholism, viral infections and accumulation of cytoplasmic fat and/or autoimmune disease.3 When the disease is irreversible and symptomatic, the prospect of survival is less than one year and, in these cases, liver transplantation may be indicated, since there are no clinical and/or surgical therapeutic alternatives. 4 The high mortality rate is present in chronic liver failure in detriment of the reduced functional capacity of the liver that can exceed 80%, a condition characterized by liver failure. In addition, this insufficiency is associated with an increased risk of developing hepatic encephalopathy. 3Hepatic encephalopathy, a neuropsychiatric syndrome characterized by changes in personality, behavior, reduction of cognition, motor function and level of consciousness is potentially reversible. However, during this clinical situation, an unfavorable prognosis with a high mortality rate is observed. 2,3Changes in anthropometric, biochemical and clinical indicators, associated with inadequate food intake are common in chronic liver disease. Changes in water compartments-ascites and peripheral edema-related to hypoalbuminemia and malnutrition are also present in the decompensated disease.1,3 Other changes present in chronic liver diseases include those related to the Intermediary metabolism of carbohydrates, lipids, proteins, vitamins and minerals that oscillate according to the degree of impairment of liver function, which negatively influences the nutritional status of these patients. 1,3,5 Studies indicate that malnutrition is present in 20% to 80% of the patients with liver disease depending on the clinical stage of the disease. There is a high prevalence of malnutrition, especially in those with decompensated cirrhosis. Already, in patients on a liver transplant list...

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