Nutritional issues in patients with obesity and cirrhosis

World J Gastroenterol. 2018 Aug 14;24(30):3330-3346. doi: 10.3748/wjg.v24.i30.3330.


Obesity and metabolic syndrome are considered as responsible for a condition known as the non-alcoholic fatty liver disease that goes from simple accumulation of triglycerides to hepatic inflammation and may progress to cirrhosis. Patients with obesity also have an increased risk of primary liver malignancies and increased body mass index is a predictor of decompensation of liver cirrhosis. Sarcopenic obesity confers a risk of physical impairment and disability that is significantly higher than the risk induced by each of the two conditions alone as it has been shown to be an independent risk factor for chronic liver disease in patients with obesity and a prognostic negative marker for the evolution of liver cirrhosis and the results of liver transplantation. Cirrhotic patients with obesity are at high risk for depletion of various fat-soluble, water-soluble vitamins and trace elements and should be supplemented appropriately. Diet, physical activity and protein intake should be carefully monitored in these fragile patients according to recent recommendations. Bariatric surgery is sporadically used in patients with morbid obesity and cirrhosis also in the setting of liver transplantation. The risk of sarcopenia, micronutrient status, and the recommended supplementation in patients with obesity and cirrhosis are discussed in this review. Furthermore, the indications and contraindications of bariatric surgery-induced weight loss in the cirrhotic patient with obesity are discussed.

Keywords: Bariatric surgery; Cirrhosis; Malnutrition; Obesity; Sarcopenia.

Publication types

  • Review

MeSH terms

  • Bariatric Surgery
  • Chronic Disease / therapy
  • Dietary Supplements
  • Exercise
  • Humans
  • Liver / pathology
  • Liver Cirrhosis / diet therapy*
  • Liver Cirrhosis / metabolism
  • Liver Cirrhosis / mortality
  • Liver Cirrhosis / pathology
  • Metabolic Syndrome / metabolism
  • Metabolic Syndrome / mortality
  • Metabolic Syndrome / pathology
  • Metabolic Syndrome / therapy*
  • Non-alcoholic Fatty Liver Disease / diet therapy*
  • Non-alcoholic Fatty Liver Disease / metabolism
  • Non-alcoholic Fatty Liver Disease / mortality
  • Non-alcoholic Fatty Liver Disease / pathology
  • Obesity, Morbid / metabolism
  • Obesity, Morbid / mortality
  • Obesity, Morbid / pathology
  • Obesity, Morbid / therapy*
  • Prognosis
  • Recommended Dietary Allowances
  • Risk Factors
  • Sarcopenia / diet therapy*
  • Sarcopenia / metabolism
  • Sarcopenia / mortality
  • Sarcopenia / pathology
  • Time Factors
  • Weight Loss