Nutritional assessment in patients with liver cirrhosis

Abstract

Malnutrition is a liver cirrhosis complication affecting more than 20%-50% of patients. Although the term can refer to either nutrient deficiency or excess, it usually relates to undernutrition in cirrhosis settings. Frailty is defined as limited physical function due to muscle weakness, whereas sarcopenia is defined as muscle mass loss and an advanced malnutrition stage. The pathogenesis of malnutrition in liver cirrhosis is multifactorial, including decreased oral intake, maldigestion/malabsorption, physical inactivity, hyperammonemia, hypermetabolism, altered macronutrient metabolism and gut microbiome dysbiosis. Patients with chronic liver disease with a Body Mass Index of < 18.5 kg/m 2 and/or decompensated cirrhosis or Child-Pugh class C are at the highest risk of malnutrition. For patients at risk of malnutrition, a detailed nutritional assessment is required, typically including a history and physical examination, laboratory testing, global assessment tools and body composition testing. The latter can be done using anthropometry, cross-sectional imaging including computed tomography or magnetic resonance, bioelectrical impedance analysis and dual-energy X-ray absorptiometry. A multidisciplinary team should screen for and treat malnutrition in patients with cirrhosis. Malnutrition and sarcopenia are associated with an increased risk of complications and a poor prognosis in patients with liver cirrhosis; thus, it is critical to diagnose these conditions early and initiate the appropriate nutritional therapy. In this review, we describe the prevalence and pathogenesis of malnutrition in liver cirrhosis patients and discuss the best diagnostic approach to nutritional assessment for them.

Optimising wound care for patients with cirrhosis: A study of the effect of combination therapy on wound healing

“…By customising diet plans and supplementing deficiencies, study effectively underscored the significance of nutritional status in wound healing. Notably, increases in albumin levels post‐treatment across all severities of cirrhosis reinforce link between improved nutritional status and wound healing capabilities 19,20 …”

“…Notably, increases in albumin levels post-treatment across all severities of cirrhosis reinforce link between improved nutritional status and wound healing capabilities. 19,20 Supplementary therapies, including NPWT, stem cell therapy and hyperbaric oxygen therapy, provided additional avenues for enhancing wound care, particularly for the more severe and complex cases. These modalities, often reserved for challenging wounds, highlighted need for the broad spectrum of treatment options in cirrhotic population, considering heterogeneity of wound presentations and responses to standard care.…”

“…Notably, increases in albumin levels post‐treatment across all severities of cirrhosis reinforce link between improved nutritional status and wound healing capabilities. 19 , 20 …”

Smart Solutions for Diet-Related Disease Management: Connected Care, Remote Health Monitoring Systems, and Integrated Insights for Advanced Evaluation

“…The most accessible but imperfect screening tool for malnutrition in LC is the body mass index (BMI), derived from a combination of anthropometric indices (height and weight in kg); a value of <18.5 kg/m 2 and the classification of LC as class C (the most severe) according to the Child-Pugh classification should immediately trigger additional nutritional screening [124]. However, in patients with sarcopenic obesity (in whom excess adipose tissue may mask the underlying loss of muscle mass) and in patients with volume overload (ascites and oedema), the BMI is suboptimal in determining the nutritional status, as it does not provide information regarding body mass composition and lean body mass.…”

From Listing to Recovery: A Review of Nutritional Status Assessment and Management in Liver Transplant Patients

“…A registered dietician or nutritionist should ideally perform it. [ 63 ]. As suggested, any cirrhotic patient should undergo a nutritional assessment every 1–6 months in the outpatient setting; for inpatients, the assessment should be conducted at admission and periodically throughout the hospital stay [ 60 ].…”