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Review
. 2020 Jun 14;26(22):2916-2930.
doi: 10.3748/wjg.v26.i22.2916.

Nutrition in alcohol-related liver disease: Physiopathology and management

Umair Kamran  1 , Jennifer Towey  2 , Amardeep Khanna  1 , Abhishek Chauhan  1 , Neil Rajoriya  1 , Andrew Holt  3
Affiliations
Review

Nutrition in alcohol-related liver disease: Physiopathology and management

Umair Kamran et al. World J Gastroenterol. .

Abstract

Malnutrition encompassing both macro- and micro-nutrient deficiency, remains one of the most frequent complications of alcohol-related liver disease (ArLD). Protein-energy malnutrition can cause significant complications including sarcopenia, frailty and immunodepression in cirrhotic patients. Malnutrition reduces patient's survival and negatively affects the quality of life of individuals with ArLD. Moreover, nutritional deficit increases the likelihood of hepatic decompensation in cirrhosis. Prompt recognition of at-risk individuals, early diagnosis and treatment of malnutrition remains a key component of ArLD management. In this review, we describe the pathophysiology of malnutrition in ArLD, review the screening tools available for nutritional assessment and discuss nutritional management strategies relevant to the different stages of ArLD, ranging from acute alcoholic hepatitis through to decompensated end stage liver disease.

Keywords: Alcohol-related liver disease; Malnutrition; Micronutrients; Nutrition support; Nutritional assessment; 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
Schematic illustration of causes and mechanisms of malnutrition in alcohol related liver disease. ArLD: Alcohol related liver disease; IL: Interleukin; TNF: Tumor necrosis factor.
Figure 2
Figure 2
Assessment of anthropometrics. MAC: Mid-arm circumference; TSF: Triceps skinfold skinfold; MAMC: Mid-arm muscle circumference.
Figure 3
Figure 3
Assessment and management of malnutrition across the stages of alcohol-related liver disease. Summary of recommendations for protein and energy intake, optimising nutrition intake across different stages of alcohol-related liver disease and in special considerations including ascites, hepatic encephalopathy, malabsorption and micronutrient deficiency. BMI: Body mass index; MAC: Mid-arm circumference; TSF: Triceps skin fold; MAMC: Mid-arm muscle circumference; HGS: Hand grip strength; SIBO: Small intestinal bacterial overgrowth.
See this image and copyright information in PMC

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