Journal of Clinical and Experimental Hepatology
Consensus StatementNutrition in Chronic Liver Disease: Consensus Statement of the Indian National Association for Study of the Liver
Section snippets
Mechanism and etiology of malnutrition in cirrhosis
Malnutrition in cirrhosis is multifactorial and may be due to inadequate dietary intake, poor absorption or metabolic disturbances. Dietary intake can be decreased due to nausea, vomiting or early satiety secondary to ascites, gastroparesis, active alcoholism, reduced palatability due to salt restriction, aphthous ulcers secondary to vitamin B complex deficiency, dysgeusia secondary to zinc deficiency and poor socio-economic status especially in the developing countries. Restriction of oral
Assessment of nutritional status in cirrhosis
BMI is an inaccurate tool for nutritional assessment in patients with cirrhosis in the presence of ascites and oedema.
Common misconceptions in dietary advice in cirrhosis
There are several myths regarding pathogenesis and treatment of malnutrition in cirrhosis. For more than half a century, protein restriction has been one of the main treatments for HE.151, 152, 153 Older clinical observations had been reported that high protein intake may worsen encephalopathy in patients with cirrhosis154, and it had become a universal practice to recommend low-protein diet to patients with cirrhosis. More recent studies have, however, shown that protein restriction has no
Nutritional treatment options for hepatic encephalopathy
Malnutrition and sarcopenia directly play a significant role in development of recurrent and overt HE apart from predisposing patients to infections.55,84,239, 240, 241 Hence, the nutritional management options in HE should focus on prevention and/or delaying progression of sarcopenia, long-term ammonia-lowering drugs/dietary interventions and supplementation of micronutrient deficiencies. The pertinent questions for nutritional treatment options for HE are given below.
Nutrition in children with chronic liver disease
Poor nutrition is observed in up to 80% of children with CLD.293,294 Infants and those with severe cholestatic liver disease are at particularly high risk of malnutrition.
Growth failure is an important predictor of survival in children with CLD and therefore has been incorporated in the paediatric end-stage liver disease (PELD) scores. Nutritional assessment in children with CLD should include physical assessment for signs of nutrient deficiency, anthropometry and biochemical tests including
Conclusions
Assessing and treating malnutrition is an essential component of treating patients with CLD. Nutritional assessment and management can be improved by close cooperation between attending interns, medical residents, physicians, hepatologists, house staff and dieticians. Reuter et al.393 assessed the nutritional status in inpatients with cirrhosis using RFH-NPT and showed there was improvement in nutritional consultations after educational training regarding nutritional guidelines of the
CRediT authorship contribution statement
Pankaj Puri: Conceptualization, Methodology, Writing – original draft, Visualization. Radha K. Dhiman: Conceptualization, Methodology, Writing – original draft, Supervision. Sunil Taneja: Writing . Puneeta Tandon: Writing . Manuela Merli: Writing . Anil C. Anand: Writing . Anil Arora: Writing . Subrat K. Acharya: Writing . Jaya Benjamin: Writing . Yogesh K. Chawla: Writing . Sunil Dadhich: Writing . Ajay Duseja: Writing . C.E. Eapan: Writing . Amit Goel: Writing . Naveen Kalra: Writing .
Conflicts of interest
The authors have none to declare.
Funding
None.
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