Nutritional Support in Chronic Liver Disease

Anne S Henkel; Alan L Buchman

Disclosures

Nat Clin Pract Gastroenterol Hepatol. 2006;3(4):202-209. 

In This Article

Sequelae

Malnutrition is associated with increased morbidity and mortality rates in patients with chronic liver disease. Patients with cirrhosis who are malnourished have a higher rate of hepatic encephalopathy, infection, and variceal bleeding.[3,16] They are also twice as likely to have refractory ascites.[8] Although numerous studies have found a correlation between poor nutritional status and a decreased survival rate, there is debate as to whether the increased mortality rate is caused by malnutrition or by the advanced liver disease itself. Alberino et al. identified malnutrition as an independent predictor of mortality in patients with cirrhosis.[1]

Nutritional status has prognostic implications in liver transplant candidates. Malnutrition before transplantation is associated with a higher rate of post-transplant complications, including infection and variceal bleeding.;[4,16,17] Patients who are severely malnourished require more blood products intraoperatively, remain on ventilatory support longer postoperatively, and have an increased length of hospital stay[3,4,9] and a higher incidence of graft failure.[18] Ultimately, patients with poor nutritional status before transplant surgery have a decreased survival rate after liver transplantation.[5,6,9]

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