Impact of Liver and Pancreas Diseases on Nutritional Status

Abstract

Liver and pancreatic diseases have significant consequences on nutritional status, with direct effects on clinical outcomes, survival, and quality of life. Maintaining and preserving an adequate nutritional status is crucial and should be one of the goals of patients with liver or pancreatic disease. Thus, the nutritional status of such patients should be systematically assessed at follow-up. Recently, great progress has been made in this direction, and the relevant pathophysiological mechanisms have been better established. While the spectrum of these diseases is wide, and the mechanisms of the onset of malnutrition are numerous and interrelated, clinical and nutritional manifestations are common. The main consequences include an impaired dietary intake, altered macro and micronutrient metabolism, energy metabolism disturbances, an increase in energy expenditure, nutrient malabsorption, sarcopenia, and osteopathy. In this review, we summarize the factors contributing to malnutrition, and the effects on nutritional status and clinical outcomes of liver and pancreatic diseases. We explain the current knowledge on how to assess malnutrition and the efficacy of nutritional interventions in these settings.

Nutritional Support in Pancreatic Diseases

“…Pancreatic exocrine insufficiency (PEI) and ChP are not the same concept. PEI occurs mainly in the context of ChP as the pancreatic parenchyma is affected, theoretically, in more than 90% [ 17 ]. PEI is defined as the pathological decrease in enzyme secretion (mainly lipase but also amylase, protease, etc.)…”

“…or bicarbonate [ 18 ], causing an insufficiency in realizing the digestive function. For this reason, there are more circumstances, in addition to ChP, in which PEI can also develop: (1) after pancreatic resection surgeries; (2) temporarily after necrotizing acute pancreatitis until parenchyma is recovered; (3) in pancreatic cancer affecting the head or neck; (4) in partial or total gastrectomy or in Zollinger-Edison syndrome, because of an inactivation of lipase due to an acidic environment in the duodenal lumen [ 17 ].…”

“…Quantification of fecal elastase in feces is the most widely used method to assess the enzymatic secretion, because elastase is a very stable enzyme formed almost exclusively in the pancreas. However, there are other direct and indirect measurement methods that are not the subject of this review [ 17 ].…”

“…The use of previously mentioned scores to perform a malnutritional screening (MUST or MST) is important [ 17 , 26 , 27 ]. The rate of patients with ChP who present malnutrition is around 30%, according to a study using the MUST score [ 20 ].…”

Renal dysfunction independently predicts muscle mass loss in patients following liver transplantation

“…Muscle mass loss appears concomitantly with malnutrition; resulting from inadequate food intake, altered nutrients digestion/absorption, and hypermetabolism (7,8). Muscle mass loss occurs at the rate of 2.2% per year in patients with cirrhosis which increases with severity of the disease (9,10).…”