Primary Care of Patients with Cirrhosis – Current and Future Challenges

Validation of a Screening Tool to Identify Undernutrition in Ambulatory Patients With Liver Cirrhosis

“…Chronic liver disease is a leading cause of death for Americans, due to a high prevalence of viral hepatitis, such as hepatitis C, as well as alcoholic liver disease and nonalcoholic fatty liver disease (NAFLD) 1 , 2 . The incidence and prevalence of hepatitis C are anticipated to decrease as a result of the possible invention of a vaccination along with current treatments for the virus, while alcoholic liver disease is anticipated to remain consistent in the future 1 , 3 . However, rates of NAFLD are anticipated to increase aggressively due to the increased rates of overweight and obesity in the American population, and thus an overall increase in the incidence and prevalence of chronic liver disease in the United States is anticipated in the future 1 – 4 .…”

“…The incidence and prevalence of hepatitis C are anticipated to decrease as a result of the possible invention of a vaccination along with current treatments for the virus, while alcoholic liver disease is anticipated to remain consistent in the future 1 , 3 . However, rates of NAFLD are anticipated to increase aggressively due to the increased rates of overweight and obesity in the American population, and thus an overall increase in the incidence and prevalence of chronic liver disease in the United States is anticipated in the future 1 – 4 . This will lead to an increased demand for healthcare resources to care for this unique population 1 , 5 , 6 …”

“…One common complication associated with advanced liver disease is malnutrition 3 – 10 . The prevalence of malnutrition among patients with cirrhosis has been estimated to be as high as 60%–80% 2 – 4 , 7 , 11 .…”

“…One common complication associated with advanced liver disease is malnutrition 3 – 10 . The prevalence of malnutrition among patients with cirrhosis has been estimated to be as high as 60%–80% 2 – 4 , 7 , 11 . Although liver cirrhosis frequently leads to changes in body composition, such as a decrease in muscle mass and subcutaneous fat, weight loss is often masked due to the presence of edema and ascites 3 , 4 , 6 – 8 , 11 .…”

“…The cause of malnutrition in liver cirrhosis is multifactorial and includes a decline in intake related to poor appetite, presence of gastrointestinal symptoms, and early satiety, as well as increased circulating levels of proinflammatory cytokines 2 – 4 , 6 – 11 . Furthermore, alterations in absorption and digestion are common in patients with liver cirrhosis and can exacerbate malnutrition 2 , 4 , 6 , 8 – 11 .…”