Causes of malnutrition in patients with liver cirrhosis

Causes of malnutrition in patients with liver cirrhosis.   The pathogenesis of malnutrition in patients with liver cirrhosis involves many factors.

The nutritional status of patients with liver cirrhosis has received more and more attention, which seriously affects the survival period, quality of life, the occurrence and development of other complications of liver cirrhosis, and the outcome after liver transplantation.

The pathogenesis of malnutrition in patients with liver cirrhosis involves many factors.

The metabolism of protein, carbohydrates and lipids are all affected by liver disease.

Promoting factors include insufficient dietary intake, impaired digestion and absorption, and metabolic changes.

1. Anorexia, nausea, encephalopathy, gastritis, ascites, sodium-restricted diet and combined drinking can all reduce dietary intake.

2. Bile salt deficiency, bacterial overgrowth, changes in intestinal motility, changes in intestinal portal hypertension, mucosal damage and increased intestinal permeability can all lead to malabsorption of nutrients and indigestion.

3. Liver cirrhosis is a state of accelerated hunger, that is, the body uses energy substances (protein, fat) other than glucose [22].

4. Reduced synthesis of urea and liver protein, reduced intestinal protein absorption and increased urine nitrogen excretion lead to total protein loss. Liver disease can cause a decrease in the ratio of branched-chain amino acid (BCAA)/aromatic amino acids.

5. Abnormal carbohydrate metabolism is related to insulin resistance, impaired gluconeogenesis and decreased glycogen reserves. As a result, lipids are preferentially oxidized for energy, so the respiratory quotient (RQ) of patients with liver cirrhosis is lower than that of patients without chronic liver disease. RQ is defined as the ratio of CO2 production to O2 consumption.

Assessment of malnutrition in liver cirrhosis includes the following aspects:

• Nutritional status assessment (overall assessment)
• Muscle mass (anthropometry, CT scan, dual-energy absorption measurement, bioimpedance analysis, muscle ultrasound)
• Muscle function (grip strength test)
• Overall physical fitness (“standing-walking” time, 6 min walking distance)

What about malnutrition in patients with liver cirrhosis?

1. Change your diet

Encourage patients with liver cirrhosis to eat small and frequent meals during the day and add meals at night to shorten the duration of the fasting state after food absorption. Fasting at night for patients with liver cirrhosis is equivalent to fasting for healthy people for 2 to 3 days. Night snacks can reduce lipid oxidation and improve nitrogen balance. Nitrogen snacks such as equal calories during the day are not equivalent to the metabolism or clinical effects of night snacks.

2. Supplement energy and protein

Patients with liver cirrhosis should ensure sufficient calorie and protein intake. Patients who cannot meet their nutritional needs after oral administration can be combined with enteral or parenteral nutrition. In patients with liver cirrhosis, increasing protein intake has been proven to be safe, beneficial, Well tolerated.

3. Supplement branched chain amino acids

BCAA is not only a component of protein and a source of glutamate, but also can synthesize glutamine through skeletal muscle, reduce blood ammonia levels, and improve hepatic encephalopathy.

4. Supplement Vitamin A and Vitamin C

Patients with chronic liver disease are prone to osteoporosis, which is called hepatic bone disease. Due to poor vitamin D conversion ability in patients with liver disease, if additional vitamin D is not supplemented, the risk of fractures is higher than that of the general population.

The storage of vitamin A depends on the liver, and it is easy to lack vitamin A when the liver is damaged. Vitamin A is related to vision, and severe vitamin A deficiency can cause night blindness.

(source:internet, reference only)

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