Management of malnutrition in liver cirrhosis: "Five Dos and Five Dons" | Summary of the article

Introduction Chronic liver disease patients usually suffer from malnutrition.
The degree of malnutrition increases with the progress of the disease (decompensated liver function) and has a significant impact on morbidity and mortality.

Malnutrition mainly occurs in patients with refractory ascites, multiple hospitalizations, cholestatic cirrhosis, or chronic long-term alcohol abuse.

However, with the increasing prevalence of obesity, diabetes and metabolic syndrome, some patients with liver cirrhosis may still be overweight or obese despite malnutrition.

Screening and evaluation of malnutrition in liver cirrhosis When managing patients with chronic liver disease or decompensated liver cirrhosis, doctors should pay attention to continue to include the nutritional status of patients in their evaluation.

The first step is to conduct a rapid nutrition screening to identify patients with "at risk", namely low body mass index (BMI) (<18), advanced liver disease (Child-Pugh grade C) and RFH-NPT (a new type of nutrition risk screening) Tool) Screen positive patients.

At-risk patients should receive a more complete nutritional assessment, including assessment of the occurrence of sarcopenia.

Obese patients may also suffer from sarcopenia (sarcopenia obesity), which should also be carefully screened.

In addition, it is recommended to ask the patient's dietary intake and attitude towards food for further evaluation.

Nutritional assessment includes the following aspects: nutritional status assessment (Royal Free Hospital overall assessment) muscle mass (anthropometrics, CT scan, dual energy absorption measurement, bioimpedance analysis, muscle ultrasound) muscle function (grip strength test) overall physical fitness ( "Stand-Walk" time, 6 min walking distance) Management of liver cirrhosis, malnutrition, "five actions" principle: Like treating other complications of chronic liver disease, pay more attention to possible malnutrition, and use simple methods to assess the patient’s Nutritional status.

Inform patients of the importance of nutrition in chronic liver disease.

Provide patients with recommendations on dietary intake (for non-overweight individuals: 30-35 kcal per kilogram of body weight per day, and 1.
2-1.
5 g of protein per day) and meal patterns (to avoid long fasting by eating supper).

Emphasize the importance of maintaining muscle mass and function through exercise.

Set a simple goal for physical activity.

"Five Don'ts" principle: Treat malnutrition as the inevitable result of disease development ("powerlessness").

Impose a lot of unreasonable diet or life>
In order to prevent or treat hepatic encephalopathy, instruct patients on a low-protein diet.

Ignore the adverse effects of long-term fasting.

Ignore the correlation between muscle mass exhaustion and the prognosis of patients with liver cirrhosis.

Literature index: Merli M.
Nutrition in cirrhosis: Dos and Don'ts.
J.
Hepatol.
2020 Sep 02.
doi: 10.
1016/j.
jhep.
2020.
07.
019.