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. #Nutrition #Cirrhosis #diet #management #hepatology #pathophysiology
