Malnutrition is prevalent in the spectrum of liver diseases. A recent published guideline by ESPEN is recommending specific methods of nutritional management for patients with different liver diseases in different stages (Plauth, et al., 2019). Some examples are given below to describe the situation in the different patients. In liver cirrhosis, the prevalence and severity of mixed type protein energy malnutrition is related to the clinical stage of chronic liver disease, ranging from 20% in patients with well compensated disease to more than 60% in patients with advanced cirrhosis (Plauth, et al., 2019). It is also associated with higher mortality.
Malnutrition is prevalent in the spectrum of liver diseases. A recent published guideline by ESPEN is recommending specific methods of nutritional management for patients with different liver diseases in different stages (Plauth, et al., 2019). Some examples are given below to describe the situation in the different patients. In liver cirrhosis, the prevalence and severity of mixed type protein energy malnutrition is related to the clinical stage of chronic liver disease, ranging from 20% in patients with well compensated disease to more than 60% in patients with advanced cirrhosis (Plauth, et al., 2019). It is also associated with higher mortality.
In several studies, a higher mortality was reported in patients with preoperative sarcopenia undergoing transplantation for end-stage chronic liver disease. Also, with other liver diseases like non-alcoholic steatohepatitis (NASH) and cirrhosis, sarcopenia is a strong predictor of mortality.
Patients with chronic liver disease and a sedentary lifestyle should receive a higher amount of calories than a healthy person (1.3x as much for non-protein-energy provision). In patients with alcoholic steatohepatitis ONS is strongly advised when caloric requirements cannot be met. Also, in the case of mild hepatic encephalopathy, ONS is recommended.
In recent published guidelines, protein intakes have been advised for liver patients (Plauth, et al., 2019). Non-malnourished patients with compensated cirrhosis should consume 1.2 g/kg body weight/day. To replenish malnourished and/or sarcopenic cirrhotic patients, the amount of 1.5 g/ kg body weight/day should be consumed. For the other liver diseases, a similar range was advised but always depending on the patient’s condition. Liver diseases very often occur in obese patients. S-core can be used in the different liver diseases following the specific advice of the ESPEN expert group.
The use of MCT oil in liver disease is still an interesting field of further research. In a rodent model it was shown that an LCT-rich diet in combination with alcohol led rats to store a far more triglycerides in the liver (8x vs control) compared to a MCT-rich diet in combination with alcohol (3x vs control) (Lieber, Lefevre, & Spritz, 1967). It was also shown that MCTs protect the liver from steatosis (Nanji, Yang, & Fogt, 1996). In a rat model for nonalcoholic fatty liver disease (NAFLD) an MCT rich diet could prevent the progression of disease (Ronis, et al., 2013). In an older study, it was concluded that MCTs have potential value in the treatment of malabsorption in patients with cirrhosis, and are not clinically contraindicated, even in patients with evidence of hepatic encephalopathy (Morgan, Bolton, Morris, & Read, 1974).
A recent publication on a rodent model, showed that a rich MCT diet benefits adiposity but had an adverse effect on markers of hepatic lipogenesis and beta-oxidation (Chamma, Bargut, Mandarim-de-Lacerda, & Aguila, 2017).
A rare condition where the supplementation of MCT oils has been shown to be beneficial is with Citrin deficiency. Citrin functions as an aspartate/glutamate transporter in the mitochondria and is essential for hepatic glycolysis (Hayasaka & Numakura, 2018). Citrin deficiency can manifest in newborns or infants as neonatal intrahepatic cholestasis caused by citrin deficiency (NICCD), in older children as failure to thrive and dylipidemia caused by citrin deficiency (FTTDCD) and in adults as recurrent hyperammonemia with neuropsychiatric symptoms in citrullinemia type II (CTLN2).
The condition has the highest prevalence in East Asia but is also found in other parts of the world (Abuduxikuer, Chen, Wang, & Wang, 2019). A major complication of cholestasis is fat malabsorption related to decreased intestinal bile acids, which leads to malnutrition and fat-soluble vitamin deficiency. MCTs can be supplemented to provide a good source of fat calories (Francavilla, Miniello, Brunetti, Lionette, & Armenio, 2003). In CTLN2 patients it even seems to delay the need for liver transplantation.
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