Siddiqui ATS, Parkash O, Hashmi SA. Malnutrition and liver disease in a developing country. World J Gastroenterol 2021; 27(30): 4985-4998 [PMID: 34497430 DOI: 10.3748/wjg.v27.i30.4985]
Corresponding Author of This Article
Om Parkash, FCPS, MBBS, Associate Professor, Department of Medicine, Division of Gastroenterology, The Aga Khan University, Stadium Road, Karachi 74800, Pakistan. om.parkash@aku.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
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/
World J Gastroenterol. Aug 14, 2021; 27(30): 4985-4998 Published online Aug 14, 2021. doi: 10.3748/wjg.v27.i30.4985
Malnutrition and liver disease in a developing country
Asra tus Saleha Siddiqui, Om Parkash, Syeda Amrah Hashmi
Asra tus Saleha Siddiqui, Department of Medicine, The Aga Khan University, Karachi 74800, Pakistan
Om Parkash, Department of Medicine, Division of Gastroenterology, The Aga Khan University, Karachi 74800, Pakistan
Syeda Amrah Hashmi, Medical College, The Aga Khan University, Karachi 74800, Pakistan
Author contributions: Siddiqui ATS, Parkash O and Hashmi SA performed the literature review and wrote the manuscript.
Conflict-of-interest statement: The authors declare no conflict of interest for this article.
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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Om Parkash, FCPS, MBBS, Associate Professor, Department of Medicine, Division of Gastroenterology, The Aga Khan University, Stadium Road, Karachi 74800, Pakistan. om.parkash@aku.edu
Received: January 28, 2021 Peer-review started: January 28, 2021 First decision: March 6, 2021 Revised: March 19, 2021 Accepted: July 2, 2021 Article in press: July 2, 2021 Published online: August 14, 2021
Abstract
Malnutrition is a highly prevalent and under recognized condition in developing countries of South Asia. The presence of malnutrition causes a severe impact on patients with liver cirrhosis. The etiology of cirrhosis differs in the South Asian region compared to the West, with hepatitis B and C still being the leading causes and the prevalence of nonalcoholic fatty liver disease increasing over time. Comorbid malnutrition worsens outcomes for cirrhosis patients. Urgent attention to address malnutrition is needed to improve patient outcomes. The etiology and pathophysiology of malnutrition in liver diseases is multifactorial, as reduction in liver function affects both macronutrients and micronutrients. A need for nutritional status assessment for liver disease patients exists in all parts of the world. There are many widely studied tools in use to perform a thorough nutritional assessment, of which some tools are low cost and do not require extensive training. These tools can be studied and evaluated for use in the resource limited setting of a country like Pakistan. Treatment guidelines for proper nutrition maintenance in chronic liver disease exist for all parts of the world, but the knowledge and practice of nutritional counseling in Pakistan is poor, both amongst patients and physicians. Emphasis on assessment for nutritional status at the initial visit with recording of vital signs is needed. Simultaneously, treating physicians need to be made aware of the misconceptions surrounding nutritional restrictions in cirrhosis so that patient education is done correctly based on proper scientific evidence.
Core Tip: Malnutrition in liver cirrhosis is a serious problem in South Asia where the etiology differs from the Western population. As malnutrition is generally highly prevalent in the region, it causes an impact on patients with liver cirrhosis. Urgent attention to address malnutrition is needed to improve patient outcomes. Emphasis on assessment for nutritional status at the initial visit with recording of vital signs is also needed. Simultaneously, treating physicians need to be made aware of the misconceptions surrounding nutritional restrictions in cirrhosis so that patient education is done correctly based on proper scientific evidence.
