[The European Association for the Study of Liver (EASL) nutrition guidelines.]

This review explores the latest guidelines on nutrition in patients with chronic liver diseases of the European Association for the Study of the Liver (EASL) and recent studies on physiopathology, clinical outcomes and possible treatments of malnutrition and sarcopenia in liver cirrhosis. Chronic liver diseases are frequently associated with malnutrition, changes in skeletal muscle and bone quality and quantity. About 20% of patients with compensated liver cirrhosis and 50% of those with decompensated cirrhosis are sarcopenic. Malnutrition and sarcopenia are associated with a higher complication rate (ascites, bacterial infections and hepatic encephalopathy) and are independent predictors of lower survival in cirrhotic patients. In recent years, concomitant with the decline of post-viral cirrhosis, patients affected by post-metabolic cirrhosis are increasing. These patients are more frequently overweight or obese, but sarcopenia may also coexist. Sarcopenic obesity has been shown to worsen the prognosis in patients with liver cirrhosis. There is a general consensus about the need of improving the nutritional status and implementing skeletal muscle mass in cirrhotic patients, but this is not always achievable. Osteoporosis is present in about 30% of cirrhotic patients, with a higher prevalence in patients with cholestasis. Treatment with phosphonates, calcium and vitamin D are recommended in association with a periodic follow-up.