Nutritional issues in patients with obesity and cirrhosis

Table 2 Nutritional recommendations for cirrhotic patients with obesity

Nutrient	Recommendation
1Daily energy intake[117]	25-35 kcal/(kg•d) in patients with BMI 30-40 kg/m2 20-25 kcal/(kg•d) in patients with BMI > 40 kg/m2
2Protein intake[119]	1.2-1.5 g/(kg•d)
3Micronutrients	Identify and correct micronutrient deficiencies
Fiber	25-45 g/d

¹The recommended dietary pattern is for small, frequent meals evenly distributed throughout the day (every 3-6 h) with a late evening snack containing at least 50 g of complex carbohydrate.

²Vegetable-protein based diets can also be beneficial in terms of caloric and fiber intake among overweight patients with cirrhosis who are attempting to lose weight. In addition, plant-based proteins are rich in branched-chain amino acids (BCAA)[117,127,128].

³Cirrhotic patients with obesity are at high risk for depletion of various fat-soluble, water-soluble vitamins and trace elements and should be supplemented appropriately. BMI: Body mass index.