ABSTRACT
Hepatic dysfunction presents a constellation of challenges in nutritional management. Patients with cirrhosis often experience anorexia as with other chronic illnesses associated with malnutrition. Sarcopenia is positively correlated with higher Child-Pugh scores, and interventions aimed at protein-energy malnutrition (PEM) treatment must consider the variable resting energy expenditure (REE) in patients with cirrhosis. Hypermetabolism is defined as a REE >120% of the predicted value and is identified in acute liver failure (ALF) and patients with cirrhosis. In addition to PEM, cirrhosis begets altered macronutrient and micronutrient metabolism in an attempt to meet altered energy demands. The absence of functional hepatocytes in patients with cirrhosis leads to impaired non-oxidative glucose metabolism. The etiology of cirrhosis may be important in addressing specific micronutrient deficiencies. Patients with alcohol use disorder and subsequent development of cirrhosis suffer from poor nutritional intake and deficiencies in B vitamins long before the development of liver disease.
