Evaluation and Management of Nutritional Consequences of Chronic Liver Diseases

Abstract

Liver diseases are the major predisposing conditions for the development of malnutrition, sarcopenia, and frailty. Recently, the mechanism of the onset of these complications has been better established. Regardless of the etiology of the underlying liver disease, the clinical manifestations are common. The main consequences are impaired dietary intake, altered macro- and micronutrient metabolism, energy metabolism disturbances, an increase in energy expenditure, nutrient malabsorption, sarcopenia, frailty, and osteopathy. These complications have direct effects on clinical outcomes, survival, and quality of life. The nutritional status should be assessed systematically and periodically during follow-up in these patients. Maintaining and preserving an adequate nutritional status is crucial and should be a mainstay of treatment. Although general nutritional interventions have been established, special considerations are needed in specific settings such as decompensated cirrhosis, alcohol-related liver disease, and metabolic-dysfunction-associated fatty liver disease. In this review, we summarize the physiopathology and factors that impact the nutritional status of liver disease. We review how to assess malnutrition and sarcopenia and how to prevent and manage these complications in this setting.

Keywords: alcohol-related liver disease; cirrhosis; frailty; liver transplantation; malnutrition; metabolic dysfunction-associated fatty liver disease; sarcopenia.

Figure 1

Main factors of sarcopenia in liver cirrhosis.

Figure 2

Algorithm for nutritional screening and assessment in liver cirrhosis.

Figure 3

Diagnosis of malnutrition and severity grading based on GLIM criteria.

Figure 4

Lifestyle recommendations for patients with MAFLD.

Figure 5

General nutritional recommendations for ALD patients.