EASL Clinical Practice Guidelines on nutrition in chronic liver disease

European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu, European Association for the Study of the Liver, Manuela Merli, Annalisa Berzigotti, Shira Zelber-Sagi, Srinivasan Dasarathy, Sara Montagnese, Laurence Genton, Mathias Plauth, Albert Parés, European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu, European Association for the Study of the Liver, Manuela Merli, Annalisa Berzigotti, Shira Zelber-Sagi, Srinivasan Dasarathy, Sara Montagnese, Laurence Genton, Mathias Plauth, Albert Parés

Abstract

A frequent complication in liver cirrhosis is malnutrition, which is associated with the progression of liver failure, and with a higher rate of complications including infections, hepatic encephalopathy and ascites. In recent years, the rising prevalence of obesity has led to an increase in the number of cirrhosis cases related to non-alcoholic steatohepatitis. Malnutrition, obesity and sarcopenic obesity may worsen the prognosis of patients with liver cirrhosis and lower their survival. Nutritional monitoring and intervention is therefore crucial in chronic liver disease. These Clinical Practice Guidelines review the present knowledge in the field of nutrition in chronic liver disease and promote further research on this topic. Screening, assessment and principles of nutritional management are examined, with recommendations provided in specific settings such as hepatic encephalopathy, cirrhotic patients with bone disease, patients undergoing liver surgery or transplantation and critically ill cirrhotic patients.

Copyright © 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Figures

Figure 1. Nutritional screening and assessment in…
Figure 1. Nutritional screening and assessment in patients with cirrhosis.
All patients should undergo a rapid screening of malnutrition using validated, accepted tools. A liver specific screening tool which takes into consideration fluid retention may be advisable (Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT). Patients found to be at high risk of malnutrition should undergo a detailed nutritional assessment, and based on the findings they should receive either supplementation or regular follow-up. †In a case of fluid retention, body weight should be corrected by evaluating the patient’s dry weight by post-paracentesis body weight or weight recorded before fluid retention if available, or by subtracting a percentage of weight based upon severity of ascites (mild, 5%; moderate, 10%; severe, 15%), with an additional 5% subtracted if bilateral pedal edema is present.
Figure 2. Mechanisms and potential targets for…
Figure 2. Mechanisms and potential targets for anabolic resistance and dysregulated proteostasis resulting in sarcopenia and/or failure to respond to standard supplementation.
Figure 3. Diagnosis and management of bone…
Figure 3. Diagnosis and management of bone disease in patients with chronic liver disease.

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