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Review
. 2018 Aug 14;24(30):3330-3346.
doi: 10.3748/wjg.v24.i30.3330.

Nutritional issues in patients with obesity and cirrhosis

Luigi Schiavo  1 , Luca Busetto  2 , Manuela Cesaretti  3 , Shira Zelber-Sagi  4 , Liat Deutsch  5 , Antonio Iannelli  6
Affiliations
Review

Nutritional issues in patients with obesity and cirrhosis

Luigi Schiavo et al. World J Gastroenterol. .

Abstract

Obesity and metabolic syndrome are considered as responsible for a condition known as the non-alcoholic fatty liver disease that goes from simple accumulation of triglycerides to hepatic inflammation and may progress to cirrhosis. Patients with obesity also have an increased risk of primary liver malignancies and increased body mass index is a predictor of decompensation of liver cirrhosis. Sarcopenic obesity confers a risk of physical impairment and disability that is significantly higher than the risk induced by each of the two conditions alone as it has been shown to be an independent risk factor for chronic liver disease in patients with obesity and a prognostic negative marker for the evolution of liver cirrhosis and the results of liver transplantation. Cirrhotic patients with obesity are at high risk for depletion of various fat-soluble, water-soluble vitamins and trace elements and should be supplemented appropriately. Diet, physical activity and protein intake should be carefully monitored in these fragile patients according to recent recommendations. Bariatric surgery is sporadically used in patients with morbid obesity and cirrhosis also in the setting of liver transplantation. The risk of sarcopenia, micronutrient status, and the recommended supplementation in patients with obesity and cirrhosis are discussed in this review. Furthermore, the indications and contraindications of bariatric surgery-induced weight loss in the cirrhotic patient with obesity are discussed.

Keywords: Bariatric surgery; Cirrhosis; Malnutrition; Obesity; Sarcopenia.

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Conflict of interest statement

Conflict-of-interest statement: No potential conflicts of interest. No financial support.

Figures

Figure 1
Figure 1
Non-alcoholic fatty liver disease and hepatic histopathological alterations. NAFLD includes a wide spectrum of histopathological alterations ranging from simple steatosis (A) to non-alcoholic steatohepatitis (B) and cirrhosis (C). NAFLD: Non-alcoholic fatty liver disease.
Figure 2
Figure 2
Sarcopenia as a prognostic negative marker in the cirrhotic patient with obesity. Cirrhotic patients with obesity frequently have a combined loss of skeletal muscle and gain of adipose tissue, culminating in the condition known as “sarcopenic obesity”. Sarcopenia in cirrhotic patients has been associated with increased mortality, sepsis complications, hyperammonemia, overt hepatic encephalopathy, and an increased length of hospital stay after liver transplantation.
See this image and copyright information in PMC

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