Abstract
Liver cirrhosis is an increasing public health threat worldwide. Malnutrition is a serious complication of cirrhosis and is associated with worse outcomes. With this review, we aim to describe the prevalence of malnutrition, pathophysiological mechanisms, diagnostic tools and therapeutic targets to treat malnutrition. Malnutrition is frequently underdiagnosed and occurs—depending on the screening methods used and patient populations studied—in 5–92% of patients. Decreased energy and protein intake, inflammation, malabsorption, altered nutrient metabolism, hypermetabolism, hormonal disturbances and gut microbiome dysbiosis can contribute to malnutrition. The stepwise diagnostic approach includes a rapid prescreen, the use of a specific screening tool, such as the Royal Free Hospital Nutritional Prioritizing Tool and a nutritional assessment by dieticians. General dietary measures—especially the timing of meals—oral nutritional supplements, micronutrient supplementation and the role of amino acids are discussed. In summary malnutrition in cirrhosis is common and needs more attention by health care professionals involved in the care of patients with cirrhosis. Screening and assessment for malnutrition should be carried out regularly in cirrhotic patients, ideally by a multidisciplinary team. Further research is needed to better clarify pathogenic mechanisms such as the role of the gut-liver-axis and to develop targeted therapeutic strategies.
Highlights
The Hepahealth report from 2018 reported a prevalence of chronic liver disease and cirrhosis in Europe between 500 and 1100 cases per 100.000 inhabitants [1]
In patients with liver cirrhosis, decreased energy and protein intake are the commonest reason leading to malnutrition [29,30,31,32,33,34,35]
If there is inadequate delivery of bile acids, as it is common in liver cirrhosis patients, this can lead to a deficiency of fat-soluble vitamins, especially in jaundiced patients [92,93]
Summary
The Hepahealth report from 2018 reported a prevalence of chronic liver disease and cirrhosis in Europe between 500 and 1100 cases per 100.000 inhabitants [1]. Cirrhosis is a systemic disease and malnutrition is a key feature as well as an important complication of the disease. This implicates that malnutrition diagnosis is relevant as one of the clinical characteristics of cirrhosis, and needs to be considered as an important complication, that warrants timely and appropriate therapy to improve prognosis. The knowledge gap is underpinned by a survey, in which only 20% of gastroenterologists gave correct answers regarding the prevalence of malnutrition in cirrhotic patients [3]. The problem of underdiagnosis can be derived from two very large studies from the USA using the national inpatient sample, that showed a much lower prevalence of 6–12%, whereas studies that used active screening for malnutrition exhibit higher rates of detection [4,5]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
