The importance of addressing poor nutrition in patients with liver failure
Poor nutrition is common in patients with liver failure, or cirrhosis, and it can lead to muscle wasting, weakness, fatigue, and worse outcomes before and after patients undergo liver transplantation. A new review published in Liver Transplantation addresses aspects of nutrition in transplant candidates with cirrhosis and emphasizes the need to screen all patients to identify those with poor nutritional status, especially those suffering from muscle wasting.
"Muscle wasting is frequently overlooked in liver transplant candidates as nutritional assessment is not routinely carried out as part of clinical practice, and an accurate assessment can be complicated by obesity or fluid retention," said the review's senior author, Aldo J. Montano-Loza, MD, MSc, PhD, of the University of Alberta. "Muscle wasting is one of the major features of undernutrition in cirrhosis, and currently, high resolution image-based techniques such as computed tomography constitute the best way to evaluate body composition in these patients."
According to Dr. Montano-Loza and his colleagues, ensuring adequate caloric and protein intake forms the foundation of therapy for undernutrition in liver transplant candidates, and patients should avoid fasting for longer than six hours. Studies have demonstrated potential for additional therapies—such as consuming branched-chain amino acids or fish oil supplements and taking hormone replacement therapy; however, their potential benefits need to be confirmed in randomized controlled trials.
"Physical activity is also an important aspect of therapy," said Dr. Montano-Loza. "Therefore, supervised mobilization should be encouraged and physiotherapy should be consulted liberally when patients are in the hospital to minimize total bed rest and muscle atrophy."
He noted that for cirrhosis patients who do not have access to dieticians and exercise specialists, it's especially important that their clinicians are aware of guideline recommendations for both diet and physical activity.