Evaluation and Management of Nutrition in Chronic Liver Disease

The majority of patients with chronic liver disease (CLD) experience malnutrition. There are multiple complex mechanism by which chronic liver disease leads to malnutrition, including anorexia and malabsorption. Assessing malnutrition in CLD is also difficult at this time as there are no standardized methods for quantifying nutritional status in this group of patients. However, newer methods are being developed to help ensure better diagnosis and thus start treatment earlier. These novel methods such as hang grip strength (HGS) and bioelectrical impedance analysis (BIA) are safe and inexpensive. However, further studies are needed to fully validate their reliability and testing in special groups, such as children. The goals of treatment are to provide adequate nutrition, support growth, preserve lean body mass, and prevent micronutrient and vitamin deficiencies. In addition to improving body mass, new studies are also focused on reducing sarcopenia (clinically relevant muscle wasting). Novel studies are revealing that improving muscle mass results in better long-term outcomes rather than just improving weight alone. This review will examine the scope of malnutrition in patients with CLD, its implications, the mechanisms by which malnutrition occurs, the methods to assess nutritional status, specific nutritional deficits, and current treatment approaches.