[Nutrition and chronic liver disease]

The prevalence, causes, and consequences of energy-protein malnutrition (EPM) are reviewed in cirrhosis and its treatment, with special emphasis on those aspects that can be carried out in the ambulatory regime. EPM is a highly prevalent situation in advanced cirrhosis, but it probably already occurs in early stages of the disease. EPM has an important prognosis in cirrhosis. Specifically, the nutritional status could be a better predictor of the evolution after a liver transplant than the conventional prognostic indicators. The increase in the oxidation of fats and proteins is the most important mechanisms in EPM in these patients. The hypermetabolism and the deficit in ingestion are also relevant factors in the EPM in cirrhosis. Conventional diet therapy is the most important tool in the long term nutritional treatment in cirrhosis. The administration of nightly carbohydrate supplements could partially revert the alteration in the oxidation of the energetic substrates in these patients. Also, oral supplements of chemically defined diets could improve the quality of life and the long term survival of these patients. When artificial nutrition is indicated, enteral nutrition is the modality of choice in these patients. Enteral nutrition in cirrhosis is safe, nutritionally effective (as it guarantees an adequate energetic-proteineic ingestion), and in some studies it has been associated with a better short term survival. Adding branched chain amino acids to the diets or enteral supplements meant for cirrhotics would only be essential in patients who show intolerance to the conventional protein. Other changes in the components of the diet formulae meant for cirrhotics are open to further research.