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Abstract

The liver is a master metabolic gland; consequently, liver disease commonly results in significant malnutrition. Complex metabolic derangements always accompany liver failure, often reflect the magnitude of hepatic insufficiency, and are characterized by accentuated catabolism. Nutritional assessment is problematic in these patients, because many of the usual indicators of nutritional status are altered directly by the hepatic pathophysiology rather than, or in addition to, preexisting or subsequent secondary malnutrition. The objective of nutritional support in patients with liver failure is to provide adequate nutrients to ensure the availability of specific substrates for energy and protein synthesis and for normal hepatocyte survival and function, without inducing or accentuating encephalopathy or otherwise compounding hepatic insufficiency. In the near future, guidelines must be developed for the specific nutritional support of patients with fulminant hepatic failure, cholestatic liver disease, steatosis, and cirrhosis. Currently, work is underway to develop an artificial liver for patients awaiting transplantation; to use genetic engineering technology to provide an alternative source of hepatic tissue; and to test the utility of various intermediary metabolites for hepatobiliary nutrition support. No ideal regimen for nutritional support of all forms of liver failure exists, and this also represents a significant challenge for future basic and clinical investigations. However, it is mandatory to attempt to maintain optimal nutrition in patients with severe liver failure if morbidity and mortality are to be reduced and survival is to be maximized.

Nutritional Therapy in Liver Transplantation

“…The liver is the largest and most crucial metabolic organ, playing a pivotal role in integrating several biochemical pathways of carbohydrate, fat, protein, and vitamin metabolism as well as the transport of lipids and the secretion and excretion of bile, all of which are processes involved in muscle and protein metabolism and central for well-nourished status [ 1 , 2 , 3 ].…”

“…An aggressive approach to ensure adequate nutritional repletion, as well as correcting vitamin and micronutrient deficiencies is central to maintain remaining hepatic function, improve the patient’s metabolic reserves, and the outcomes after LT [ 1 ]. Hence, timely nutrition assessment and patient tailored intervention for anticipated recipients or those on the waiting list may improve outcomes surrounding LT [ 1 , 2 , 3 ].…”

Dietary methionine can sustain cytosolic redox homeostasis in the mouse liver

“…The liver regulates systemic homeostasis of sugars, lipids, amino acids, nucleosides, vitamins, steroid hormones, and other compounds 28 , including sulfur- and seleno-amino acids 29 , with hepatocyte Trx1- and GSH-systems participating in these processes 11 , 30 . Here, however, we report that hepatic function and, thereby, organismal survival, is sustained in mice lacking both TrxR1 and GR in all hepatocytes.…”

A Step Closer to the “Fourth 90”: A Practical Narrative Review of Diagnosis and Management of Nutritional Issues of People Living with HIV

“…In fact, a malnourished state characterizes patients with cirrhosis [146] because of deficient nutrient intake, malabsorption, and altered metabolism of lipids, proteins, and carbohydrates caused by liver dysfunction. Because of portal hypertension and cirrhosis, nutrients are not properly metabolized in the liver and are not fully available for biologic functions [147]. Furthermore, in patients with cirrhosis, it is common to find a deficit of liposoluble vitamins (vitamins A, D, E, and K) because of reduced production of bile salt, highlighting the importance of vitamin supplementation in these subjects [148].…”