Nutrition and liver disease

Malnutrition occurs in 65–90% of patients with chronic liver disease. Malnutrition, including micronutrient deficiencies, can precipitate decompensation, and the overall nutritional state is recognised as an important predictor of survival in cirrhosis. A variety of mechanisms contribute to malnutrition in chronic liver disease: poor dietary intake, malabsorption, increased protein losses, low protein synthesis, disturbances in substrate utilisation and hypermetabolism. The Subjective Global Assessment of nutrition is based on the history, examination and/or simple anthropometry, and has been shown to be an effective screening tool to detect malnutrition in liver disease. Nutritional therapy is an important part of the management of fulminant liver failure. While patients are being medically stabilised, hypoglycaemia is a common problem and parenteral glucose administration is often necessary. Liver dysfunction is common in patients with intestinal failure receiving parenteral nutrition. End-stage intestinal failure-associated liver disease is an indication for small intestine and/or liver transplantation.