Nutrition in Hepatocellular Carcinoma: Pathophysiological Insights, Impact, and Implications for Clinical Practice

Hepatocellular carcinoma (HCC) is the third leading cause of cancer-related mortality worldwide. Malnutrition is highly prevalent among people living with HCC and has a substantial impact on morbidity and mortality. Nutrition influences the development of HCC and is also a consequence of chronic liver disease and liver cancer. Routine screening and nutritional assessment using validated tools, along with evaluation of muscle mass and functional status, are essential in the optimal care of patients with HCC. Nutritional interventions may change throughout the disease trajectory depending on the stage of HCC, the severity of liver cirrhosis, and the overall treatment options and intent. Evidence supports the use of oral nutritional supplements, branched-chain amino acids, exercise interventions, and the preferential use of enteral over parenteral nutrition. Optimizing nutrition is integral to HCC management across all disease stages and is best accomplished with a multidisciplinary team to individualize the nutritional care across the disease continuum. In this review, we summarize current evidence on the impact and role of nutritional therapy in HCC and provide actionable recommendations for clinical practice. We highlight the current challenges and provide future directions for future HCC nutritional care pathways.