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Nutritional assessment in chronic liver disease

Puneeta Tandon, MD, FRCPC
Leah Gramlich, MD, FRCPC
Section Editor
Timothy O Lipman, MD
Deputy Editor
Kristen M Robson, MD, MBA, FACG


Protein calorie malnutrition (PCM) has been described in 50 to 100 percent of patients with decompensated cirrhosis and at least 20 percent with compensated cirrhosis [1-5]. PCM is associated with a number of complications including development of variceal bleeding and ascites, increased surgical morbidity and mortality, reduced survival, and (in some studies) worsening hepatic function [2,6-12]. Patients with cirrhosis (particularly those with advanced disease) may also have micronutrient deficiencies. Recognition of macro- and micronutrient deficiencies is important since supplemental nutrition has been associated with a reduction in the risk of infection and in-hospital mortality and improved liver function parameters [13-16].


The pathogenesis of malnutrition in cirrhosis is multifactorial [5]. Protein, carbohydrate, and lipid metabolism are all affected by liver disease. Contributing factors include inadequate dietary intake, impaired digestion and absorption, and altered metabolism.

Anorexia, nausea, encephalopathy, gastritis, ascites, a sodium-restricted diet, and concurrent alcohol consumption can all contribute to a reduction in dietary intake.

Malabsorption and maldigestion of nutrients can result from bile salt deficiency, bacterial overgrowth, altered intestinal motility, portal hypertensive changes to the intestine, mucosal injury, and increased intestinal permeability [17-21].

Cirrhosis represents an accelerated state of starvation and as such, fuels other than glucose (protein, lipids) are used [22].

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Literature review current through: Nov 2017. | This topic last updated: Aug 17, 2015.
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