[Nutrition and chronic liver disease].

Area of Science:

• Gastroenterology and Hepatology
• Nutritional Science
• Clinical Medicine

Context:

• Energy-protein malnutrition (EPM) is highly prevalent in cirrhosis, affecting both early and advanced stages.
• Nutritional status is a critical prognostic indicator in cirrhosis, potentially surpassing conventional metrics for predicting post-liver transplant outcomes.
• Understanding the mechanisms of EPM, including increased fat and protein oxidation, hypermetabolism, and reduced intake, is vital for effective management.

Purpose:

• To review the prevalence, causes, consequences, and treatment of energy-protein malnutrition (EPM) in cirrhosis.
• To emphasize ambulatory management strategies for EPM in cirrhosis.
• To highlight the prognostic significance of nutritional status in cirrhosis and liver transplantation.

Summary:

• EPM is a significant issue in cirrhosis, with increased substrate oxidation and reduced intake as key drivers.
• Conventional diet therapy is the cornerstone of long-term nutritional management.
• Nightly carbohydrate supplements and oral chemically defined diets may improve quality of life and survival.
• Enteral nutrition is the preferred method for artificial nutrition, proving safe and effective.
• Branched-chain amino acid supplementation is indicated for protein-intolerant patients.

Impact:

• Nutritional interventions can significantly improve outcomes for cirrhosis patients.
• Early identification and management of EPM can enhance patient survival and quality of life.
• Further research into optimized dietary formulas for cirrhotic patients is warranted.