Nutrition in liver cirrhosis: a case-based overview

Malnutrition is defined as a deficiency or excess (or imbalance) of energy, protein and other nutrients and is most often associated with undernutrition.2 3 In cirrhosis, this is closely associated with a reduction in muscle mass, function and strength, known as sarcopenia.4 Collectively, malnutrition and sarcopenia negatively impact on a patients’ ability to complete daily tasks, quality of life, liver-related morbidity and mortality.1 5–10 Given the increasing prevalence of obesity, diabetes and their association with non-alcoholic fatty liver disease (NAFLD), an imbalance of nutritional intake is becoming increasingly observed in patients with cirrhosis.11 12 The resultant combination of adiposity and sarcopenia, termed ‘sarcopenic obesity’, poses unique nutritional challenges, with regard to optimising metabolic risk factors (ie, weight loss, glycaemic/lipid control) and muscle function. Dietetic intake consisted of high fat content foods (crisps, chips, fried meats, fizzy drinks), but infrequent breakfasts. [...]as patients with cirrhosis have poor glycogen reserves, an overnight fast is the equivalent of a 3-day fast in healthy individuals. [...]patients with cirrhosis have excessive muscle protein breakdown (proteolysis) to mobilise amino acids to maintain gluconeogenesis, thereby resulting in sarcopenia. Indirect calorimetry (uses oxygen uptake, carbon dioxide production ± nitrogen excretion to determine this) is the most accurate method of doing so, but is impractical in clinic. [...]the following international targets are used3 13: