Published online Jun 14, 2020. doi: 10.3748/wjg.v26.i22.2916
Peer-review started: January 31, 2020
First decision: February 27, 2020
Revised: May 8, 2020
Accepted: May 21, 2020
Article in press: May 21, 2020
Published online: June 14, 2020
Malnutrition encompassing both macro- and micro-nutrient deficiency, remains one of the most frequent complications of alcohol-related liver disease (ArLD). Protein-energy malnutrition can cause significant complications including sarcopenia, frailty and immunodepression in cirrhotic patients. Malnutrition reduces patient’s survival and negatively affects the quality of life of individuals with ArLD. Moreover, nutritional deficit increases the likelihood of hepatic decompensation in cirrhosis. Prompt recognition of at-risk individuals, early diagnosis and treatment of malnutrition remains a key component of ArLD management. In this review, we describe the pathophysiology of malnutrition in ArLD, review the screening tools available for nutritional assessment and discuss nutritional management strategies relevant to the different stages of ArLD, ranging from acute alcoholic hepatitis through to decompensated end stage liver disease.
Core tip: Malnutrition is a common complication of alcohol-related liver disease (ArLD), which, if untreated, can adversely affect patient outcome and recovery. Prompt recognition of nutritional depletion may identify those patients who are at higher risk of clinical decompensation, but there are few guidelines to inform the clinical management of these complex patients. In this article, we discuss the pathophysiology and treatment of micro- and macro-nutrient deficiency in ArLD, and provide recommendations for the management of patients at different stages of their illness.