Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 14, 2020; 26(22): 2916-2930
Published online Jun 14, 2020. doi: 10.3748/wjg.v26.i22.2916
Nutrition in alcohol-related liver disease: Physiopathology and management
Umair Kamran, Jennifer Towey, Amardeep Khanna, Abhishek Chauhan, Neil Rajoriya, Andrew Holt
Umair Kamran, Amardeep Khanna, Abhishek Chauhan, Neil Rajoriya, Andrew Holt, The Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, United Kingdom
Jennifer Towey, Department of Dietetics, Queen Elizabeth Hospital Birmingham, Birmingham B15 2GW, United Kingdom
Abhishek Chauhan, Centre for Liver Research, Institute of Immunology and Inflammation, and National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, The Medical School, University of Birmingham, Birmingham B15 2TT, United Kingdom
Author contributions: Kamran U and Towey J equally contributed to the generation of this article and are acknowledged in equal standing in position of authorship. Kamran U and Khanna A performed literature search; Kamran U was leaded with writing original draft, contributed in the conceptualization; Kamran U and Towey J contributed to designing article; Towey J contributed to writing nutritional assessment and management sections; Khanna A wrote pathophysiology section; Chauhan A provided input in writing abstract and discussion; Rajoriya N and Holt A equally contributed to overall supervision in the generation of the manuscript and are acknowledged in equal standing in position of authorship, making critical revisions related to important intellectual content and approving final version of article to be published; Holt A contributed to conception.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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:
Corresponding author: Andrew Holt, FRCP, PhD, Doctor, Consultant Hepatologist, The Liver Unit, Queen Elizabeth Hospital Birmingham, Mindelsohn Way Edgbaston, Birmingham B15 2GW, United Kingdom.
Received: January 31, 2020
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.

Keywords: Malnutrition, Sarcopenia, Alcohol-related liver disease, Nutritional assessment, Nutrition support, Micronutrients

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.