Abstract
Malnutrition is common for patients with chronic liver disease (CLD), it significantly aggravates prognosis for their quality of life and overall survival. Liver cirrhosis (LC) is one of the most severe CLD manifestations. The main causes of malnutrition at CL include insufficient food intake (deficiency of nutrients, especially proteins), malabsorption, metabolic disorders (predominance of gluconeogenesis rather than glycogenolysis) and changes in substrate metabolism (hypermetabolism). Sarcopenia, which is defined by loss of muscle mass and function, is a major component of malnutrition in patients with cirrhosis. It is important to note that sarcopenia adversely affects the number and severity of complications, quality of life, the outcome of liver transplantation and the overall survival rate of patients with advanced liver disease.Physicians of different specialties should be aware of the clinical and prognostic relevance of nutritional status, how to promptly recognize malnutrition and sarcopenia in patients with liver cirrhosis and how to appropriately manage these conditions.This paper elucidates methods of assessment of the nutritional status of patients and screening for sarcopenia, the main pathogenetic links in sarcopenia development, dietary recommendations (including diet in case of hepatic encephalopathy development), tactics of curation of patients with eating disorders. Particular attention is paid to assessing the presence of eating disorders in the process of selection of patients for transplantation and for TIPS. Recommendations are given for educating the caregivers for patients with chronic liver disease and informing patients about the risks of developing sarcopenia/sarcopenic obesity.This article discusses some of the most common errors in assessing the diet of patients with chronic liver disease, as well as current practical recommendations based on evidence that will allow physicians to avoid possible future errors in the care of such patients.
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