Nutrition in patients with cirrhosis

Malnutrition is a common complication of cirrhosis, increases in frequency with Child-Turcotte-Pugh (CTP) score, and is associated with an increased morbidity and mortality. Although malnutrition is easily recognized in chronically ill patients with CTP class C cirrhosis, it is present but often unrecognized in up to 50% of patients with CTP class A cirrhosis; thus, all patients with cirrhosis, regardless of etiology or severity, should be screened for malnutrition. A nutritional screening should be incorporated into the routine clinical care of patients with cirrhosis, with a more extensive nutritional assessment that includes a detailed history, dietary recall, baseline nutrition laboratory tests, and evaluation of sarcopenia using imaging modalities or strength testing to determine the degree of frailty. A thorough assessment will allow for a personalized treatment plan that provides the patient with total daily caloric intake goals with an emphasis on quality protein, education on timing of oral intake with a reduction in periods of fasting, identification and treatment of micronutrient deficiencies, and recommendation of safe and realistic exercise programs to help prevent and/or reduce sarcopenia and improve frailty.