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

Table 1 Nutrition guidelines in cirrhosis

Guideline	Target population/scope	Energy (kcal/kg/day)	Protein (g/kg/day)	Meal timing/late-evening snack
EASL clinical practice guidelines	Adults with chronic liver disease/cirrhosis	30-40 kcal/kg/day (use dry/ideal weight if ascites)	1.2-1.5 g/kg/day (higher if sarcopenic)	Recommends small frequent meals and late-evening carbohydrate snack to reduce overnight catabolism
ESPEN guideline/practical guideline	Clinical nutrition for liver disease (comprehensive recommendations + practical flowcharts)	30-40 kcal/kg/day (adjust for obesity/edema)	1.2-1.5 g/kg/day (critically ill 12-2.0 g/kg/day as needed)	Recommends late-evening snacks and multiple small meals, practical guidance for implementation
INASL consensus statement (India)	Nutrition in CLD-adults and children; context-sensitive (resource settings)	Recommends individualized approximately 30-40 kcal/kg/day; use ideal/dry weight for ascites	1.2-1.5 g/kg/day (higher for sarcopenia; adjust for comorbidity)	Advises small frequent meals and night snack (starch/CHO) to prevent fasting catabolism
AASLD practice guidance-malnutrition/frailty/sarcopenia in cirrhosis	Practical guidance for malnutrition, frailty and sarcopenia in cirrhosis	Aligns with approximately 30-40 kcal/kg/day goals; advises individualized targets	1.2-1.5 g/kg/day stable patients; increase to approximately 1.5 g/kg if sarcopenic; critically ill targets higher	Supports avoidance of prolonged fasting; recommends late-evening snacks to reduce catabolism
ACG clinical guideline-malnutrition and nutritional recommendations in liver disease	New guidance covering malnutrition across liver disease spectrum	Recommends early screening and individualized energy (ranges like others; emphasises dry/ideal weight)	Recommends 1.2-1.5 g/kg/day (with adjustments for sarcopenia, critical illness)	Reiterates multiple small meals + late snack, practical implementation advice in United States practice settings

EASL: European Association for the Study of the Liver; ESPEN: European Society for Clinical Nutrition and Metabolism; INASL: Indian National Association for the Study of the Liver; CLD: Chronic liver disease; CHO: Carbohydrates; AASLD: American Association for the Study of Liver Diseases; ACG: American College of Gastroenterology.