Alcoholic liver disease and malnutrition

Abstract

Malnutrition, both protein energy malnutrition (PEM) and deficiencies in individual nutrients, is a frequent complication of alcoholic liver disease (ALD). Severity of malnutrition correlates with severity of ALD. Malnutrition also occurs in patients with cirrhosis due to etiologies other than alcohol. The mechanisms for malnutrition are multifactorial, and malnutrition frequently worsens in the hospital due to fasting for procedures and metabolic complications of liver disease, such as hepatic encephalopathy. Aggressive nutritional support is indicated in inpatients with ALD, and patients often need to be fed through an enteral feeding tube to achieve protein and calorie goals. Enteral nutritional support clearly improves nutrition status and may improve clinical outcome. Moreover, late-night snacks in outpatient cirrhotics improve nutritional status and lean body mass. Thus, with no FDA-approved therapy for ALD, careful nutritional intervention should be considered as frontline therapy.

Fig. 1

Patient with alcoholic cirrhosis with severe PEM as determined by subjective global assessment with ascites and muscle wasting (left panel). This was corrected with 2 years of abstinence (right panel).

Fig. 2

Mortality correlated in a dose-response fashion with voluntary calorie intake in patients with alcoholic hepatitis. Numbers in parentheses indicate the number of patients.