Abstract
Liver and pancreatic diseases have significant consequences on nutritional status, with direct effects on clinical outcomes, survival, and quality of life. Maintaining and preserving an adequate nutritional status is crucial and should be one of the goals of patients with liver or pancreatic disease. Thus, the nutritional status of such patients should be systematically assessed at follow-up. Recently, great progress has been made in this direction, and the relevant pathophysiological mechanisms have been better established. While the spectrum of these diseases is wide, and the mechanisms of the onset of malnutrition are numerous and interrelated, clinical and nutritional manifestations are common. The main consequences include an impaired dietary intake, altered macro and micronutrient metabolism, energy metabolism disturbances, an increase in energy expenditure, nutrient malabsorption, sarcopenia, and osteopathy. In this review, we summarize the factors contributing to malnutrition, and the effects on nutritional status and clinical outcomes of liver and pancreatic diseases. We explain the current knowledge on how to assess malnutrition and the efficacy of nutritional interventions in these settings.
Highlights
Even if the detrimental effects of malnutrition associated with liver and pancreatic diseases are well known, the scientific knowledge of a successful strategy to correct this manifestation is controversial, and the goal of contributing to such knowledge is difficult to achieve in the clinical practice [1,17]
Malnutrition is frequent in patients with liver cirrhosis, which progresses in parallel with the worsening of the disease
The main mechanisms underlying osteoporosis in patients with chronic liver disease are vitamin K deficiency, vitamin D and calcium metabolism alterations, hormonal dysregulation, and proinflammatory cytokines related to “leaky gut syndrome” and IGF-1 deficiency [34]. These abnormalities differ depending on the etiology: in cholestatic liver disease, deficiencies of vitamin K and D represent the main cause of metabolic osteopathy; in hemochromatosis, there is an associated hypogonadism that can explain this condition; in Metabolic Associated Fatty Liver Disease (MAFLD), viral hepatitis and alcoholic liver disease, the increase in proinflammatory cytokine production represents the pathophysiological mechanism
Summary
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. In patients with pancreatic disease, malnutrition is associated with increased mortality and hospitalization rates, a low quality of life, and poorer survival in patients with advanced pancreatic cancer [4,10,11,12]. Given these data, maintaining and preserving an adequate nutritional status is crucial and should be one of the goals of such patients. Even if the detrimental effects of malnutrition associated with liver and pancreatic diseases are well known, the scientific knowledge of a successful strategy to correct this manifestation is controversial, and the goal of contributing to such knowledge is difficult to achieve in the clinical practice [1,17]. We summarize the current knowledge on the management of malnutrition and the efficacy of nutritional interventions in these settings
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