Malnutrition and Sarcopenia in Patients with Liver Cirrhosis: the Importance of Nutritional Assessment and Evidence-Based Interventions

Abstract

Malnutrition and sarcopenia are frequently present in patients with liver cirrhosis. The prevalence is estimated to be between 23% and 60%, which may be even higher in patients on the liver transplant waiting list. Both conditions are associated with a higher rate of complications and are independent predictors of lower survival.¹

The etiology of malnutrition/sarcopenia in liver cirrhosis is multifactorial and results from a combination of alterations in intake and nutrient digestion, absorption and metabolism. Poor dietary intake may result from gastrointestinal symptoms, anorexia, dysgeusia, prolonged fasting and inadequate dietary prescriptions. Malabsorption may be secondary to portal hypertension or cholestatic disease. However, impaired macronutrient metabolism is a central mechanism that contributes significantly to malnutrition, as peripheral insulin resistance and reduced hepatic glycogen stores promote early gluconeogenesis, leading to protein and lipid catabolism. This may occur in the face of a short overnight fast and resemble the catabolic state of healthy subjects undergoing 2-3 days of starvation.²