Abstract
Malnutrition has become a dangerously common problem in children with chronic liver disease, negatively impacting neurocognitive development and growth. Furthermore, many children with chronic liver disease will eventually require liver transplantation. Thus, this association between malnourishment and chronic liver disease in children becomes increasingly alarming as malnutrition is a predictor of poorer outcomes in liver transplantation and is often associated with increased morbidity and mortality. Malnutrition requires aggressive and appropriate management to correct nutritional deficiencies. A comprehensive review of the literature has found that infants with chronic liver disease (CLD) are particularly susceptible to malnutrition given their low reserves. Children with CLD would benefit from early intervention by a multi-disciplinary team, to try to achieve nutritional rehabilitation as well as to optimize outcomes for liver transplant. This review explains the multifactorial nature of malnutrition in children with chronic liver disease, defines the nutritional needs of these children, and discusses ways to optimize their nutritional.
Highlights
The liver plays a crucial role in many of the body’s metabolic processes, including regulating protein, fat, and carbohydrate metabolism; vitamin storage and activation; and detoxification and excretion of waste products [1]
Children with chronic liver disease (CLD) can have higher levels of pro-inflammatory cytokines, which have been correlated with malnutrition due to increased levels of pro-inflammatory cytokines, which have been correlated with malnutrition due to increased energy consumption [31]
Calcium and magnesium are often depleted in CLD, as vitamin D stimulates their absorption from the intestines
Summary
The liver plays a crucial role in many of the body’s metabolic processes, including regulating protein, fat, and carbohydrate metabolism; vitamin storage and activation; and detoxification and excretion of waste products [1]. It results from hepatic injury leading to irreversible impairment of liver function, with changes in architecture and blood supply [3] This results in impaired synthesis of serum proteins and clotting factors, compromised glycemic control and ammonia metabolism, and impaired bile secretion and cholestasis [4]. The overall incidence of liver disease in neonates in the United States is approximately 1 in every 2500 live births [6] with extrahepatic biliary atresia, metabolic disorders, and neonatal hepatitis being the most common causes of CLD in neonates [7]. United States, common causes of CLD include metabolic disorders, chronic intrahepatic cholestasis, obesity-related steatohepatitis, drug- and toxin-induced disorders, and viral hepatitis [5]. This review discusses the multi-factorial mechanisms behind malnutrition in children with CLD, as well as strategies to optimize nutritional support in children with CLD
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