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Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 14, 2018; 24(30): 3330-3346
Published online Aug 14, 2018. doi: 10.3748/wjg.v24.i30.3330
Nutritional issues in patients with obesity and cirrhosis
Luigi Schiavo, Luca Busetto, Manuela Cesaretti, Shira Zelber-Sagi, Liat Deutsch, Antonio Iannelli
Luigi Schiavo, Department of Translational Medical Science, University of Campania “Luigi Vanvitelli”, Naples 80131, Italy
Luigi Schiavo, IX Division of General Surgery, Vascular Surgery and Applied Biotechnology, Naples University Policlinic, Naples 80131, Italy
Luca Busetto, Department of Medicine, University of Padua, Padua 35128, Italy
Luca Busetto, Center for the Study and the Integrated Management of Obesity, University Hospital of Padua, Padua 35128, Italy
Manuela Cesaretti, Department of HPB Surgery and Liver Transplantation, Hôpital Beaujon, AP-HP, Clichy 92110, France
Manuela Cesaretti, Department of Nanophysics, Italian Institute of Technology, Genova 16163, Italy
Shira Zelber-Sagi, School of Public Health, University of Haifa, Haifa 3498838, Israel
Shira Zelber-Sagi, Liat Deutsch, Department of Gastroenterology and Liver disease, Tel Aviv Medical Center, 62431, Tel-Aviv 62431, Israel
Liat Deutsch, The Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 62431, Israel
Antonio Iannelli, Digestive Unit, Archet 2 Hospital, University Hospital of Nice, F-06202, Nice, France; Inserm, U1065, Team 8 “Hepatic complications of obesity”, Nice F-06204, France
Antonio Iannelli, University of Nice Sophia-Antipolis, Nice F-06107, France
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonio Iannelli, MD, PhD, Professor, Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 151 route Saint Antoine de Ginestiere, Nice F-06202, France. iannelli.a@chu-nice.fr
Telephone: +33-310-2678771 Fax: +33-310-2678772
Received: April 3, 2018
Peer-review started: April 4, 2018
First decision: May 30, 2018
Revised: June 15, 2018
Accepted: June 25, 2018
Article in press: June 25, 2018
Published online: August 14, 2018
Abstract

Obesity and metabolic syndrome are considered as responsible for a condition known as the non-alcoholic fatty liver disease that goes from simple accumulation of triglycerides to hepatic inflammation and may progress to cirrhosis. Patients with obesity also have an increased risk of primary liver malignancies and increased body mass index is a predictor of decompensation of liver cirrhosis. Sarcopenic obesity confers a risk of physical impairment and disability that is significantly higher than the risk induced by each of the two conditions alone as it has been shown to be an independent risk factor for chronic liver disease in patients with obesity and a prognostic negative marker for the evolution of liver cirrhosis and the results of liver transplantation. Cirrhotic patients with obesity are at high risk for depletion of various fat-soluble, water-soluble vitamins and trace elements and should be supplemented appropriately. Diet, physical activity and protein intake should be carefully monitored in these fragile patients according to recent recommendations. Bariatric surgery is sporadically used in patients with morbid obesity and cirrhosis also in the setting of liver transplantation. The risk of sarcopenia, micronutrient status, and the recommended supplementation in patients with obesity and cirrhosis are discussed in this review. Furthermore, the indications and contraindications of bariatric surgery-induced weight loss in the cirrhotic patient with obesity are discussed.

Keywords: Obesity, Cirrhosis, Sarcopenia, Malnutrition, Bariatric surgery

Core tip: Obesity is a frequent cause of chronic liver disease that can progress to cirrhosis. Cirrhotic patients with obesity frequently have alterations in specific aspects of nutritional status, such as poor protein intake and micronutrient deficiencies. Diet, physical activity and protein intake should be carefully monitored. Bariatric surgery may be an option in the management of patients with morbid obesity and cirrhosis also in the setting of liver transplantation but scientific evidence is still scarce.