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Liver plays a key role in maintaining an appropriate nutritional status in healthy individuals through metabolism of protein, carbohydrates, and fat. In individuals with chronic liver disease (CLD), the role that the organ plays in nutrition maintenance is affected to a considerable extent.
A review published in the World Journal of Hepatology summarized the evidence in the clinical approach of dealing with nutrition in patients with chronic liver disease and cirrhosis. The review highlighted the approach to nutritional support in patients with CLD, including investigating the etiology, clinical assessment and key investigations, as well as management.
Common causes of CLD include hepatitis C, alcoholic liver disease, and non-alcoholic liver disease. In this patient population, impaired nutritional maintenance most commonly manifests as protein-calorie malnutrition. Besides the inherent abnormalities in metabolism, CLD can also be associated with anorexia and heightened metabolic requirements, thus contributing to a state of malnutrition.
Prognosis is closely linked with nutrition. Therefore, proper nutritional assessment is crucial and can be achieved through a thorough history and physical examination, as well as biochemical investigations and anthropometry.
An appropriate assessment of a patients nutritional status helps devise a management approach. The management approach is primarily based on the extent of malnutrition which mirrors the severity of disease.
Management options can largely be segregated into enteral and parenteral nutrition. Enteral nutrition is usually sufficient in the form of oral supplements in less severe cases of malnutrition; however, with worsening CLD, parenteral nutrition becomes necessary.
Appropriate assessment and early intervention can go a long way in preventing complications of CLD, and improving patient outcomes.
Source: Shergill R, Syed W, Rizvi SA, Singh I. Nutritional support in chronic liver disease and cirrhotics. World J Hepatol. 2018 Oct 27;10(10):685-694.