Malnutrition as an indirect cause of mortality in cirrhosis patients – Is it possible to prevent it?

Cirrhosis patients often experience different problems derived from a malfunctioning liver, and malnutrition is one of the most common issues. As the liver has a key role in regulating the overall nutritional state and the energy balance, a liver that is not functioning properly will affect the body in various ways.

According to data from National Center for Biotechnology Information, on average, cirrhosis patients lose 7.7 ± 12.4 kg due to malnutrition and it gets worse with the severity of their underlying liver problem. Poor nutritional status is often associated with a bad prognosis as the risks of mortality and infection are higher.

A common, but difficult issue to tackle – why?

Malnutrition is a common problem in cirrhosis patients, affecting up to 60% of the patient population. There is not just a single cause that contributes to malnutrition, but rather the cause is multifactorial – various reasons that come from a malfunctioning liver contribute to this condition:

1) Inadequate intake of nutrients caused by

• Loss of appetite due to the altered sense of taste or anorexia
• Dietary restriction (e.g. low sodium)
• Pain during eating
• Generalised weakness and immobility
• Poverty from the cost of cirrhosis treatments

2) Poor digestion and poor absorption caused by

• Reduction in bile salt (which is used to digest fats)
• Alcohol-related small bowel damage (food is passed down more quickly than usual)
• Bacterial overgrowth

3) Increased energy expenditure caused by

• Diarrhoea and bleeding that cause nutrient losses
• A raised resting energy expenditure (requires more energy to do things)

Why do we have to tackle the problem of malnutrition?

Malnutrition contributes to a lot of the complications of cirrhosis as this problem affects different organs of the body. Even though it is still not sure if malnourished cirrhosis patients have a higher mortality rate or patients who pass away are more likely to be malnourished, it is clear that poor nutrition has a poor prognosis effect on cirrhosis patients. According to a research that studies the body composition and muscle function of cirrhosis patients, half of them are protein depleted and have reduced muscle function.

It’s a serious issue, but what can I do about it?

Current treatments for malnutrition includes following a nutritional recommendation, so that patients have a balanced intake of nutrients such as protein and vitamins, which are the major nutrients that most cirrhosis patients lack. Since the problem of malnutrition comes from a liver in bad condition, one of the most effective ways is to manage the health of the liver. When the health of the liver gradually improves, the problem of malabsorption, poor digestion, and loss of appetite will slowly go away.