Impact of Liver and Pancreas Diseases on Nutritional Status

Abstract

Liver and pancreatic diseases have significant consequences on nutritional status, with direct effects on clinical outcomes, survival, and quality of life. Maintaining and preserving an adequate nutritional status is crucial and should be one of the goals of patients with liver or pancreatic disease. Thus, the nutritional status of such patients should be systematically assessed at follow-up. Recently, great progress has been made in this direction, and the relevant pathophysiological mechanisms have been better established. While the spectrum of these diseases is wide, and the mechanisms of the onset of malnutrition are numerous and interrelated, clinical and nutritional manifestations are common. The main consequences include an impaired dietary intake, altered macro and micronutrient metabolism, energy metabolism disturbances, an increase in energy expenditure, nutrient malabsorption, sarcopenia, and osteopathy. In this review, we summarize the factors contributing to malnutrition, and the effects on nutritional status and clinical outcomes of liver and pancreatic diseases. We explain the current knowledge on how to assess malnutrition and the efficacy of nutritional interventions in these settings.

Keywords: liver cirrhosis; liver transplant; malabsorption; malnutrition; minerals; nutritional assessment; pancreatic exocrine insufficiency; sarcopenia; vitamins.

Figure 1

GLIM criteria for malnutrition diagnosis. At least one phenotypic criterion and one etiologic criterion are required.

Figure 2

Radiological features of chronic pancreatitis. (a) MR image shows irregular pancreatic duct (PD) contour and ductal dilatation. (b) CT image also shows moderately to markedly irregular PD contour and ductal dilatation. Calcifications in neck and body of pancreas and a metallic biliary stent in head can be observed.