Evaluation and Management of Nutritional Consequences of Chronic Liver Diseases

Abstract

Liver diseases are the major predisposing conditions for the development of malnutrition, sarcopenia, and frailty. Recently, the mechanism of the onset of these complications has been better established. Regardless of the etiology of the underlying liver disease, the clinical manifestations are common. The main consequences are impaired dietary intake, altered macro- and micronutrient metabolism, energy metabolism disturbances, an increase in energy expenditure, nutrient malabsorption, sarcopenia, frailty, and osteopathy. These complications have direct effects on clinical outcomes, survival, and quality of life. The nutritional status should be assessed systematically and periodically during follow-up in these patients. Maintaining and preserving an adequate nutritional status is crucial and should be a mainstay of treatment. Although general nutritional interventions have been established, special considerations are needed in specific settings such as decompensated cirrhosis, alcohol-related liver disease, and metabolic-dysfunction-associated fatty liver disease. In this review, we summarize the physiopathology and factors that impact the nutritional status of liver disease. We review how to assess malnutrition and sarcopenia and how to prevent and manage these complications in this setting.

Screening and assessment of malnutrition in patients with liver cirrhosis

“…The Royal Free Hospital Global Assessment (RFH-GA) was also derived from the SGA and is primarily used to determine the nutritional status of cirrhotic patients. However, this approach is time consuming and requires trained personnel to obtain consistent results, which limits its broad usage ( 15 , 18 ).…”

“…Resting energy expenditure accounts for 60–70% of total energy expenditure in healthy individuals ( 13 ) and is often increased in patients with cirrhosis due to hypermetabolism, inflammatory response, and immunosuppression ( 14 ). Patients with cirrhosis tend to have increased protein metabolism and decreased synthesis in close relation to malnutrition ( 15 ). Hormonal mediation of malnutrition is complex, and it includes the major orexigenic (appetite) hormone, gastrin, as well as a variety of anorexigenic (satiety) hormones, including leptin, cholecystokinin, glucagon-like peptide-1, peptide YY, oxyntomodulin, and pancreatic polypeptide ( 16 , 17 ).…”