Nutrition and liver diseases

Abstract

Malnutrition and micronutrient deficiencies are common in patients with liver diseases. The pathogenesis of protein-energy malnutrition in cirrhosis involves many factors, including poor oral intake, malabsorption, and metabolic abnormalities similar to stress. Encephalopathy may complicate cirrhosis but is usually not caused by diet. Protein restriction is only necessary in rare patients with refractory encephalopathy. The use of branched-chain amino-acid solutions is not supported by the literature. Chronic liver diseases without cirrhosis are not usually associated with protein-energy malnutrition, but vitamin and mineral deficiencies are common, especially with significant cholestasis. Fatty liver may result from excessive triglyceride uptake and production by the liver or by a secretory defect. Therapy for fatty liver depends on its cause. Chronic total parenteral nutrition may induce fatty liver and inflammation especially in patients with short-bowel syndrome. Deficiency of choline in parenteral nutrition has been proposed as the mechanism for liver disease. Acute liver diseases such as fulminant hepatic failure or alcoholic hepatitis are considered hypercatabolic diseases and thus require prompt nutritional intervention with a high-calorie enteral or parenteral formula. In fulminant hepatic failure, low-protein, fluid-restricted formulas are recommended.

The Management of Hospitalized Patients with Cirrhosis: The Mount Sinai Experience and a Guide for Hospitalists

“…It is easy for a cirrhotic patient to miss many meals during their hospitalization because they are often off the floor or kept fasting for long periods of time while awaiting diagnostic or therapeutic procedures. All patients should be offered nutritional supplementation and a bedtime snack [32]. Additionally, these patients can suffer from dysgeusia and often complain of early satiety, particularly if they have large or tense ascites.…”

Effects of low fat and babassu fat diets on nutritional status in obstructive cholestasis in young rats

“…A reduction in the concentration of biliary acids and the consequent malabsorption of fats, are responsible for a considerable reduction in energy utilization of the diet, resulting in malnutrition 6 . In chronic liver disease, malnutrition can contribute to gradual hepatic deterioration and, in many cases, result in death due to liver failure 7 .…”

Untitled

“…Chronic hepatic insufficiency usually occurs with endstage cirrhosis in which much of the liver has been replaced by scar tissue. The reserve capacity of the liver is so great that 80%–90% of liver cells must be injured before these functions are manifestly impaired 2…”

“…Most of the current information on nutrition in liver disease is derived from studies of patients with endstage cirrhosis of various etiologies. Some data are also available in patients with acute alcoholic hepatitis, and even less is known about nutrition in noncirrhotic chronic liver diseases such as chronic hepatitis, chronic cholestasis, or hepatic steatosis 2…”