Haj Ali S, Abu Sneineh A, Hasweh R. Nutritional assessment in patients with liver cirrhosis. World J Hepatol 2022; 14(9): 1694-1703 [PMID: 36185724 DOI: 10.4254/wjh.v14.i9.1694]
Corresponding Author of This Article
Sara Haj Ali, MBBS, Assistant Professor, Department of Internal Medicine, Faculty of Medicine, Al-Balqa Applied University, Alquds Alarabia Street, Salt 19117, Jordan. sara.hajali@bau.edu.jo
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Sep 27, 2022; 14(9): 1694-1703 Published online Sep 27, 2022. doi: 10.4254/wjh.v14.i9.1694
Nutritional assessment in patients with liver cirrhosis
Sara Haj Ali, Awni Abu Sneineh, Reem Hasweh
Sara Haj Ali, Reem Hasweh, Department of Internal Medicine, Faculty of Medicine, Al-Balqa Applied University, Salt 19117, Jordan
Awni Abu Sneineh, Department of Gastroenterology and Hepatology, University of Jordan, Faculty of Medicine, Amman 11942, Jordan
Author contributions: Haj Ali S collected data and wrote the draft; Abu Sneineh A critically revised the manuscript; Hasweh R collected data and wrote the draft.
Conflict-of-interest statement: All authors report no relevant conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sara Haj Ali, MBBS, Assistant Professor, Department of Internal Medicine, Faculty of Medicine, Al-Balqa Applied University, Alquds Alarabia Street, Salt 19117, Jordan. sara.hajali@bau.edu.jo
Received: July 14, 2022 Peer-review started: July 14, 2022 First decision: July 27, 2022 Revised: August 9, 2022 Accepted: September 9, 2022 Article in press: September 9, 2022 Published online: September 27, 2022
Abstract
Malnutrition is a liver cirrhosis complication affecting more than 20%-50% of patients. Although the term can refer to either nutrient deficiency or excess, it usually relates to undernutrition in cirrhosis settings. Frailty is defined as limited physical function due to muscle weakness, whereas sarcopenia is defined as muscle mass loss and an advanced malnutrition stage. The pathogenesis of malnutrition in liver cirrhosis is multifactorial, including decreased oral intake, maldigestion/malabsorption, physical inactivity, hyperammonemia, hypermetabolism, altered macronutrient metabolism and gut microbiome dysbiosis. Patients with chronic liver disease with a Body Mass Index of < 18.5 kg/m2 and/or decompensated cirrhosis or Child-Pugh class C are at the highest risk of malnutrition. For patients at risk of malnutrition, a detailed nutritional assessment is required, typically including a history and physical examination, laboratory testing, global assessment tools and body composition testing. The latter can be done using anthropometry, cross-sectional imaging including computed tomography or magnetic resonance, bioelectrical impedance analysis and dual-energy X-ray absorptiometry. A multidisciplinary team should screen for and treat malnutrition in patients with cirrhosis. Malnutrition and sarcopenia are associated with an increased risk of complications and a poor prognosis in patients with liver cirrhosis; thus, it is critical to diagnose these conditions early and initiate the appropriate nutritional therapy. In this review, we describe the prevalence and pathogenesis of malnutrition in liver cirrhosis patients and discuss the best diagnostic approach to nutritional assessment for them.
Core Tip: Malnutrition is a common complication of liver cirrhosis that is not often addressed by physicians. Due to its association with poor outcomes, it is important to identify patients at risk of malnutrition in order to treat them early. We herein describe the mechanism of malnutrition in cirrhosis and discuss the best diagnostic approach.
