Nutritional support in chronic liver disease and cirrhotics

Abstract

The liver is a major organ and an essential component in maintaining an appropriate nutritional status in healthy individuals through metabolism of protein, carbohydrates, and fat. In individuals with chronic liver disease (CLD), along with a number of other essential functions that the liver serves, its role in nutrition maintenance is severely impaired. Common causes of CLD include hepatitis C, alcoholic liver disease, and non-alcoholic liver disease. Amongst this population, the most common manifestation of impaired nutritional maintenance is protein-calorie malnutrition. Aside from inherent abnormalities in metabolism, such as malabsorption and maldigestion, CLD can be associated with anorexia as well as increased metabolic requirements, all of which contribute to a state of malnutrition. Given the systemic implications and impact on prognosis of malnutrition, proper nutritional assessment is essential and can be achieved through a thorough history and physical, as well as biochemical investigations and anthropometry as needed. Following an appropriate assessment of a patient’s nutritional status, an approach to management can be decided upon and is based on the extent of malnutrition which directly reflects the severity of disease. Management options can be grossly separated into enteral and parenteral nutrition. The former is usually sufficient in the form of oral supplements in less severe cases of malnutrition, but as the CLD worsens, parenteral nutrition becomes necessary. With appropriate assessment and early intervention, many of the complications of CLD can be avoided, and ultimately better outcomes can be achieved.

Royal Free Hospital-Nutritional Prioritizing Tool improves the prediction of malnutrition risk outcomes in liver cirrhosis patients compared with Nutritional Risk Screening 2002

“…The liver plays an important role in the metabolism of carbohydrates, proteins and fat (25,26) . Dysfunction of the liver contributes to malnutrition, which can develop occultly in the early stage of chronic liver disease and can ultimately lead to protein-energy malnutrition (6,7) . The identification of patients at risk of malnutrition in a hospital setting with an effective and simple nutrition risk screening tool is essential; such a tool would enable earlier nutrition assessment and more timely interventions, leading to reductions in morbidity and mortality in patients with cirrhosis (6) .…”

“…Dysfunction of the liver contributes to malnutrition, which can develop occultly in the early stage of chronic liver disease and can ultimately lead to protein-energy malnutrition (6,7) . The identification of patients at risk of malnutrition in a hospital setting with an effective and simple nutrition risk screening tool is essential; such a tool would enable earlier nutrition assessment and more timely interventions, leading to reductions in morbidity and mortality in patients with cirrhosis (6) . Previous European studies suggested that the RFH-NPT was more sensitive than the NRS-2002 for the assessment of the risk of malnutrition and the prediction of disease progression and outcomes in patients with chronic liver disease based on regression analysis (11,12,16,17) .…”

“…The onset and/or severity of malnutrition proceeds from a compromised nutritional state to an obvious loss of weight and finally to a lean body mass. It is not only associated with the progression of liver dysfunction (5) but is also related to complications of liver cirrhosis, such as infections, hepatic encephalopathy and ascites (6,7) . Early nutritional intervention is essential to reduce the length of hospital stay and healthcare-associated costs, improve quality of life and decrease the mortality rate (8,9) .…”

Comparison between criteria for diagnosing malnutrition in patients with advanced chronic liver disease: GLIM group proposal versus different nutritional screening tools

“…Protein‐calorie malnutrition is frequent in advanced chronic liver disease (ACLD), ranging from 20% to 60%, depending on the stage of the disease; it is related to higher morbidity and mortality ( 1 ) . Its pathogenesis is multifactorial; reduced dietary intake, nutrient malabsorption, anabolic resistance and increased energy expenditure are causes associated with malnutrition in these patients ( 2 ) .…”

Nutrition Parameters for Assessing Malnutrition in a Population of US Veterans With Hepatitis C Virus

“…2 Malnutrition in HCV is associated with increased mortality and morbidity. [3][4][5] The pathology of liver disease significantly alters digestion, absorption, storage, and metabolism of macronutrients and micronutrients. Anorexia, nausea, vomiting, and other gastrointestinal (GI) symptoms can lead to poor dietary intake and perpetuate the risk of malnutrition.…”