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World J Hepatol. Oct 27, 2018; 10(10): 685-694
Published online Oct 27, 2018. doi: 10.4254/wjh.v10.i10.685
Nutritional support in chronic liver disease and cirrhotics
Ravi Shergill, Wajahat Syed, Syed Ali Rizvi, Ikjot Singh
Ravi Shergill, Radiology Department, McMaster University, Hamilton, ON L8S4L8, Canada
Wajahat Syed, Syed Ali Rizvi, Ikjot Singh, Undergraduate Medicine, McMaster University, Hamilton, ON L8S4L8, Canada
Author contributions: Shergill R drafted the initial manuscript, conceived of the idea, and conducted research; Syed W, Rizvi SA and Singh I assisted with data analysis and editing of the final manuscript.
Conflict-of-interest statement: No conflict of interest.
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: Ravi Shergill, MD, BSc, Radiology Department, McMaster University, 1280 Main Street West, Hamilton, ON L8S4L8, Canada. ravi.shergill@medportal.ca
Telephone: +1-905-8699614
Received: June 27, 2018
Peer-review started: June 30, 2018
First decision: July 19, 2018
Revised: August 4, 2018
Accepted: August 6, 2018
Article in press: August 6, 2018
Published online: October 27, 2018
Abstract

The liver is a major organ and an essential component in maintaining an appropriate nutritional status in healthy individuals through metabolism of protein, carbohydrates, and fat. In individuals with chronic liver disease (CLD), along with a number of other essential functions that the liver serves, its role in nutrition maintenance is severely impaired. Common causes of CLD include hepatitis C, alcoholic liver disease, and non-alcoholic liver disease. Amongst this population, the most common manifestation of impaired nutritional maintenance is protein-calorie malnutrition. Aside from inherent abnormalities in metabolism, such as malabsorption and maldigestion, CLD can be associated with anorexia as well as increased metabolic requirements, all of which contribute to a state of malnutrition. Given the systemic implications and impact on prognosis of malnutrition, proper nutritional assessment is essential and can be achieved through a thorough history and physical, as well as biochemical investigations and anthropometry as needed. Following an appropriate assessment of a patient’s nutritional status, an approach to management can be decided upon and is based on the extent of malnutrition which directly reflects the severity of disease. Management options can be grossly separated into enteral and parenteral nutrition. The former is usually sufficient in the form of oral supplements in less severe cases of malnutrition, but as the CLD worsens, parenteral nutrition becomes necessary. With appropriate assessment and early intervention, many of the complications of CLD can be avoided, and ultimately better outcomes can be achieved.

Keywords: Chronic liver disease, Cirrhosis, Energy requirements, Nutrition, Malnutrition, Anthropometry, Liver

Core tip: This paper highlights the most recent evidence in the clinical approach to dealing with nutrition in patients with chronic liver disease and cirrhotics. We will review the pathophysiology of liver disease, etiology, and management of nutrition.