Nutrition in Chronic Liver Disease: Consensus Statement of the Indian National Association for Study of the Liver

Abstract

Malnutrition and sarcopenia are common in patients with chronic liver disease and are associated with increased risk of decompensation, infections, wait-list mortality and poorer outcomes after liver transplantation. Assessment of nutritional status and management of malnutrition are therefore essential to improve outcomes in patients with chronic liver disease. This consensus statement of the Indian National Association for Study of the Liver provides a comprehensive review of nutrition in chronic liver disease and gives recommendations for nutritional screening and treatment in specific clinical scenarios of malnutrition in cirrhosis in adults as well as children with chronic liver disease and metabolic disorders.

Keywords: ACLF, acute on chronic liver failure; ASM, appendicular skeletal muscle mass; BCAA, branched chain amino acids; BIA, bioimpedance analysis; BMD, bone mineral densitometry; BMI, body mass index; CLD, chronic liver disease; CS, corn-starch; CT, computed tomography; CTP, Child–Turcotte–Pugh; DEXA, dual-energy X-ray absorptiometry; EASL, European Association for the Study of the Liver; ESPEN, European society for Clinical Nutrition and Metabolism; GSD, glycogen storage disease; HGS, hand-grip strength; IBW, ideal body weight; IEM, inborn error of metabolism; INASL, Indian National Association for Study of the Liver; L3, third lumbar; LFI, Liver Frailty Index; MCT, medium-chain triglyceride; MELD, model for end-stage liver disease; MLD, metabolic liver disease; MRI, magnetic resonance imaging; RDA, recommended daily allowance; REE, NASH; RFH-NPT, Royal Free Hospital-Nutritional Prioritizing Tool; SMI, skeletal muscle index; Sarcopenia; TEE, total energy expenditure; chronic liver disease; cirrhosis; malnutrition; non-alcoholic liver disease, resting energy expenditure; nutrition.

Figure 1

Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) for determining nutritional risk in cirrhosis (Reprinted with permission from Amodio P, Bemeur C, Butterworth R, Cordoba J, Kato A, Montagnese S, et al. The nutritional management of hepatic encephalopathy in patients with cirrhosis: International Society for Hepatic Encephalopathy and Nitrogen Metabolism Consensus. Hepatology. 2013;58(1):325-36.).