The Nutrition Landscape in Chronic Liver Disease

Malnutrition, frailty, sarcopenia and visceral sarcopenic obesity (VSO) are common in chronic liver disease. We aim to provide a comprehensive review of basic nutrition related concepts in chronic liver disease, review the implications of nutritional abnormalities and discuss current management recommendations.

Malnutrition is an overarching concept related to an imbalance of nutrients. Frailty is related to reduction in physical strength & function and is identified via hand grip strength, the liver frailty index and the six minute walk test. Sarcopenia is progressive reduction in skeletal muscle. Sarcopenia and VSO can be identified with the use of cross-sectional imaging and are associated with increased mortality and adverse health related outcomes in the pre- and posttransplantation settings. Glucagon-like peptide-1 receptor agonists and glucose-dependent insulinotropic polypeptide can prevent progression of disease in metabolic dysfunctionassociated steatotic liver disease, promote weight loss in chronic liver disease patients with obesity and VSO and are associated with decreased mortality in the pre & post liver transplant settings. Bariatric and endobariatric interventions are being used to manage chronic liver disease patients with obesity and VSO in pre & post-transplant.

Malnutrition, frailty, sarcopenia and visceral sarcopenic obesity (VSO) are common in chronic liver disease. GLP-1 RAs are effective in the pre & post liver transplant settings; however, careful monitoring for the development of worsened or new sarcopenia is warranted. Further investigation into the role of surgical and endoscopic bariatric interventions in the pre & post liver transplant settings is warranted.