Nutrition in Cirrhosis: Dos and Don’ts

Screening:

 • Patients at risk for RFH-Nutritional Prioritizing Tool

 • Low BMI (<18.5)

 • Advanced liver disease (Child-Pugh score C)

Assessment:

 • Evaluation of nutritional status (Royal Free Hospital Global Assessment)

 • Muscle mass (Anthropometry, CT scan, Dual Energy Exchange Absorptiometry, Biolectrical Impedance Analysis, muscle ultrasound)

 • Muscle function (Handgrip test)

 • Global physical performance (Time up and go, 6 min walk distance)

DOS:

 • Take care of malnutrition as you do for other complications of chronic liver diseases.

 • Get used to make an assessment of nutritional status with simple methods.

 • Inform the patient about the importance of nutrition in chronic liver disease.

 • Provide simple messages regarding dietary intake (in non-overweight individuals 30-35 kcal/body weight, 1.2-1.5 g of proteins/kg BW) and meal pattern (avoiding long fasting by having a late evening snack).

 • Emphasize the importance of maintaining muscle mass and function by avoiding hypomobility.

 • Introduce easy targets for physical activity. 

DON’TS

 • Approach malnutrition as inevitable consequence of the disease (”Nothing can be done”)

 • Overload the patient with numerous unjustified dietary or lifestyle restrictions.

 • Prescribe low protein diets to prevent or treat hepatic encephalopathy.

 • Disregard the detrimental effect of long fasting periods.

 • Overlook the relevance of muscle mass depletion on the prognosis in patients with liver cirrhosis.



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