An article published in The Korean Journal of Gastroenterology reported that when liver disease is severe, the prognosis can be worse if the patient is malnourished. Adequate nutritional support for patients with liver diseases can improve the patients condition and prognosis.

The author stated that in cases with liver cirrhosis, malnutrition can occur due to numerous causes including poor oral intake, maldigestion, malabsorption, associated renal disease and metabolic abnormalities. For nutritional assessment, it is important to check the dietary intake, change in body composition, including anthropometry along with a functional assessment of muscles. While counselling and oral or enteral nutrition is preferred over parenteral nutrition as in other diseases.

If esophageal varices are present, care should be taken when installing a feeding tube. If there are ascites, percutaneous endoscopic gastrostomy is contraindicated because of the risk of complications. Calories of 30-35 kcal/kg/day and protein from 1.2-1.5 g/kg/day are appropriate; protein restriction is unnecessary unless the hepatic encephalopathy is severe. Furthermore, a late evening snack and branched chain amino acids can be helpful. In the case of cholestasis, the supply of manganese and copper should be restricted.

This article also informed that sarcopenia in patients with liver cirrhosis is also prevalent and is associated with the prognosis.

 Source: Lee TH. Nutritional Assessment and Management for Patients with Chronic Liver Disease. The Korean Journal of Gastroenterology. 2018;71(4):185-91.