Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2021 Feb 7;13(2):540.
doi: 10.3390/nu13020540.

Malnutrition in Patients with Liver Cirrhosis

Julia Traub  1 , Lisa Reiss  1 , Benard Aliwa  2 , Vanessa Stadlbauer  2
Affiliations
Review

Malnutrition in Patients with Liver Cirrhosis

Julia Traub et al. Nutrients. .

Abstract

Liver cirrhosis is an increasing public health threat worldwide. Malnutrition is a serious complication of cirrhosis and is associated with worse outcomes. With this review, we aim to describe the prevalence of malnutrition, pathophysiological mechanisms, diagnostic tools and therapeutic targets to treat malnutrition. Malnutrition is frequently underdiagnosed and occurs-depending on the screening methods used and patient populations studied-in 5-92% of patients. Decreased energy and protein intake, inflammation, malabsorption, altered nutrient metabolism, hypermetabolism, hormonal disturbances and gut microbiome dysbiosis can contribute to malnutrition. The stepwise diagnostic approach includes a rapid prescreen, the use of a specific screening tool, such as the Royal Free Hospital Nutritional Prioritizing Tool and a nutritional assessment by dieticians. General dietary measures-especially the timing of meals-oral nutritional supplements, micronutrient supplementation and the role of amino acids are discussed. In summary malnutrition in cirrhosis is common and needs more attention by health care professionals involved in the care of patients with cirrhosis. Screening and assessment for malnutrition should be carried out regularly in cirrhotic patients, ideally by a multidisciplinary team. Further research is needed to better clarify pathogenic mechanisms such as the role of the gut-liver-axis and to develop targeted therapeutic strategies.

Keywords: cirrhosis; dysbiosis; gut–liver axis; macronutrients; malnutrition; micronutrients; nutritional assessment; nutritional screening.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Factors contributing to malnutrition in cirrhosis. Created with BioRender.com.
Figure 2
Figure 2
Reasons for decreased energy and protein intake in cirrhosis. Created with BioRender.com.
Figure 3
Figure 3
Algorithm to screen for and assess malnutrition in cirrhosis, adapted from the European Association for the Study of the Liver (EASL) clinical practices guidelines [145]. Created with BioRender.com.
See this image and copyright information in PMC

References

    1. Pimpin L., On Behalf of the HEPAHEALTH Steering Committee . HEPAHEALTH Project Report. Europeal Association for the Study of the Liver; Geneva, Switzerland: 2018.
    1. Tapper E.B., Parikh N.D. Mortality due to cirrhosis and liver cancer in the United States, 1999–2016: Observational study. BMJ. 2018;362:k2817. doi: 10.1136/bmj.k2817. - DOI - PMC - PubMed
    1. Gundling F., Seidl H., Pehl C., Schmidt T., Schepp W. How close do gastroenterologists follow specific guidelines for nutrition recommendations in liver cirrhosis? A survey of current practice. Eur. J. Gastroenterol. Hepatol. 2009;21:756–761. doi: 10.1097/MEG.0b013e328311f281. - DOI - PubMed
    1. Patel A., Silverman S., Baghdadi J., Shah O., Sundaram V. Osteoporotic Fracture Risk and Health Care Burden in Patients With Cirrhosis. J. Clin. Gastroenterol. 2019;53:543–548. doi: 10.1097/MCG.0000000000001105. - DOI - PubMed
    1. Sam J., Nguyen G.C. Protein-calorie malnutrition as a prognostic indicator of mortality among patients hospitalized with cirrhosis and portal hypertension. Liver Int. 2009;29:1396–1402. doi: 10.1111/j.1478-3231.2009.02077.x. - DOI - PubMed

LinkOut - more resources