REVIEW  NEW PERSPECTIVES IN HEPATOLOGY: MANAGEMENT OF COMPLEX LIVER DISEASES 

Minerva Gastroenterology 2021 March;67(1):11-22

DOI: 10.23736/S2724-5985.20.02776-2

Copyright © 2020 EDIZIONI MINERVA MEDICA

lingua: Inglese

Malnourished cirrhotic patient: what should we do?

Salvatore S. SCIARRONE, Alberto ZANETTO, Francesco P. RUSSO, Giacomo GERMANI, Martina GAMBATO, Sara BATTISTELLA, Monica PELLONE, Sarah SHALABY, Patrizia BURRA, Marco SENZOLO ✉

Unit of Multivisceral Trasplants, Department of Surgery Oncology and Gastroenterology, Padua University Hospital, Padua, Italy

Malnutrition and sarcopenia have a high prevalence in cirrhotic patients. Frailty generally overlaps with malnutrition and sarcopenia in cirrhosis, leading to increased morbidity and mortality. Rapid nutritional screening assessment should be performed in all patients with cirrhosis, and more specific tests for sarcopenia should be performed in those at high risk. The pathogenesis of malnutrition in cirrhosis is complex and multifactorial and it is not just due to reduction in protein and calorie intake. Nutritional management in malnourished patients with cirrhosis should be undertaken by a multidisciplinary team to achieve adequate protein/calorie intake. While the role of branched-chained amino acids remains somewhat contentious in achieving a global benefit of decreasing mortality- and liver-related events, these latter and vitamin supplements, are recommended for those with advanced liver disease. Novel strategies to reverse sarcopenia such as hormone supplementation, long-term ammonia-lowering agents and myostatin antagonists, are currently under investigation. Malnutrition, sarcopenia and frailty are unique, inter-related and multidimensional problems in cirrhosis which require special attention, prompt assessment and appropriate management as they significantly impact morbidity and mortality.

KEY WORDS: Malnutrition; Sarcopenia; Liver cirrhosis