Malnutrition in Cirrhosis and Its Management

The World Health Organization defines malnutrition as a term referring to deficiencies, excesses, or imbalances in a person’s intake or energy and/or nutrients. Malnutrition is a nearly universal complication of end-stage liver disease, with a prevalence of up to 90%. Given their hepatic synthetic dysfunction, patients with cirrhosis are at a particularly high risk for protein-calorie depletion, which has been reported in over half of patients with cirrhosis and worsens with disease severity. Undernutrition is a potent predictor of adverse outcomes in cirrhotic patients, including lower survival rates, hepatic decompensation, longer length of days in the hospital and intensive care unit (ICU), increased number of infection episodes, and higher resource utilization. On the other hand, excess energy intake, or overnutrition, is increasingly being recognized as an important determinant of long-term outcomes in this population, particularly those with nonalcoholic steatohepatitis. Nearly one quarter of patients with cirrhosis are overnourished and up to 72% show excessive daily intake of energy and protein. In this review, we will consider the full spectrum of malnutrition in patients with end-stage liver disease and highlight key areas in need of further investigation. This review contains 4 figures, 4 tables, and 54 references. Key Words: frailty, inflammation, nocturnal feeding, nutritional assessment, nutritional risk, nutritional screening, protein-energy malnutrition, sarcopenia