Malnutrition and liver disease in a developing country

Abstract

Malnutrition is a highly prevalent and under recognized condition in developing countries of South Asia. The presence of malnutrition causes a severe impact on patients with liver cirrhosis. The etiology of cirrhosis differs in the South Asian region compared to the West, with hepatitis B and C still being the leading causes and the prevalence of nonalcoholic fatty liver disease increasing over time. Comorbid malnutrition worsens outcomes for cirrhosis patients. Urgent attention to address malnutrition is needed to improve patient outcomes. The etiology and pathophysiology of malnutrition in liver diseases is multifactorial, as reduction in liver function affects both macronutrients and micronutrients. A need for nutritional status assessment for liver disease patients exists in all parts of the world. There are many widely studied tools in use to perform a thorough nutritional assessment, of which some tools are low cost and do not require extensive training. These tools can be studied and evaluated for use in the resource limited setting of a country like Pakistan. Treatment guidelines for proper nutrition maintenance in chronic liver disease exist for all parts of the world, but the knowledge and practice of nutritional counseling in Pakistan is poor, both amongst patients and physicians. Emphasis on assessment for nutritional status at the initial visit with recording of vital signs is needed. Simultaneously, treating physicians need to be made aware of the misconceptions surrounding nutritional restrictions in cirrhosis so that patient education is done correctly based on proper scientific evidence.

Keywords: Liver cirrhosis; Liver diseases; Malnutrition; Micronutrients; Nutrition assessment; Nutritional and metabolic diseases.

Figure 1

Pathophysiology of malnutrition as a consequence of cirrhosis and the multiple pathways that lead to it. AAA: Aromatic amino acids; BCAA: Branched chain amino acids.

Figure 2

Pathophysiology of malnutrition as a consequence of cirrhosis and the multiple pathways that lead to it. GI: Gastrointestinal; NASH: Nonalcoholic steatohepatitis; TNF: Tumor necrosis factor.