Feeding the Child with Liver Disease

A Review and Practical Clinical Guide

Kathryn Mary Smart; George Alex; Winita Hardikar


J Gastroenterol Hepatol. 2011;26(5):810-815. 

In This Article

Abstract and Introduction


Nourishing children with liver disease is a challenging task; however, appropriate assessment and well-timed nutritional interventions are paramount for a good long-term outcome in these patients. An appropriate balance of macronutrients, micronutrients, and vitamins is important, as is the route of administration. This review aims to highlight the practical points in nutrition assessment and also provides a guide to the various nutritional interventions available for children with chronic liver disease.


Pediatric liver disease is rare and has many varied etiologies. Nutrition management is dependent on whether the presenting liver disease is acute, chronic, or caused by an inborn error of metabolism. Optimal nutrition is important in preventing further damage to the liver by increasing energy available for synthesis, storage, and detoxification functions.[1] Nutrition also promotes growth, improves immunological status, and maximizes the success of liver transplantation.[2–5] Poor nutrition pretransplant in a child with chronic liver disease (CLD) can also contribute to long-term post-transplant complications, such as linear growth failure, delayed intellectual development, and metabolic bone disease.[2,4,6] These patients provide a significant challenge, especially when the liver disease is cholestatic and its onset is in the first months of life.[3,7,8] Portal hypertension, organomegaly, and ascites can all contribute to enteral feed intolerance, particularly in the young infant. In addition to these problems, the use of often unpalatable, modified formulas and dietary supplements provides a further challenge in the provision of optimal nutrition in these children.

CLD will be the main focus of this paper. The nutrition management of liver disease caused by inborn errors of metabolism is beyond the scope of this review.


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