Optimizing nutritional interventions in chronic liver disease: Etiology-specific strategies for enhanced clinical management

Abstract

Malnutrition in chronic liver disease (CLD) is a critical, though often overlooked, complication. Results show that up to ninety percent of patients with advanced CLD suffer from protein calorie malnutrition. The study reviews existing literature to see the role of the underlying liver disease on the clinical outcomes of CLD. This narrative review examines the pathophysiological mechanisms of how CLD causes undernutrition (in particular, the anorexia, malabsorption, metabolic disturbances, and iatrogenic factors) and processes related to validate tools such as Subjective Global Assessment, Mid-Upper Arm Circumference and handgrip strength. This includes fat-soluble vitamin deficiency in cholestatic liver disease, micronutrient losses in alcoholic liver disease, and altered protein metabolism in viral hepatitis and non-alcoholic fatty liver disease among others. The evidence shows that early-individualized nutrition, such as high-calorie, high-protein diet, micronutrient repletion, enteral nutrition, and avoiding unnecessary restriction, improves clinical outcome, reduces complications, and enhances quality of life. Effective strategies implementation needs a multidisciplinary approach with hepatologists, dieticians and allied health professionals. This report gives a need for standardization in nutritional screening, constant monitoring of these patients, and the addition of personalized nutrition in hepatology routines in practice as an essential component in CLD management.

Keywords: Chronic liver disease; Malnutrition; Protein-calorie malnutrition; Sarcopenia; Nutritional assessment; Micronutrient deficiencies; Enteral nutrition; Hepatic encephalopathy; Cirrhosis; Nutritional therapy

Core Tip: Patients with chronic liver disease (CLD) may suffer from malnutrition, which may affect more than 90% of advanced CLD patients. The CLD review notes several mechanisms for nutritional deterioration including anorexia, malabsorption, and alterations of metabolism and outlines evidence-based, etiology-specific nutritional strategies. Inclusive of early assessment, multidisciplinary team care, individual-based intervention, nutritional management in CLD can greatly enhance patient outcomes and decrease disease burden.