Nutrition Support in End-Stage Liver Disease

Protein-calorie malnutrition (PCM) results after several weeks to months of insufficient dietary intake of protein and calories, increased protein and energy requirements, impaired use of macronutrients (eg, protein, carbohydrates, lipid, and total energy), or malabsorption of protein and energy, respectively. PCM is an increasingly recognized complication in both alcoholic and nonalcoholic liver disease. 1–5 PCM is associated with increased morbidity and mortality 2,4 in patients with end-stage liver disease (ESLD), including those awaiting liver transplantation. 6–9 The liver facilitates the synthesis of key plasma proteins; plays a major role in regulation of carbohydrate, fat, and protein metabolism; and serves as a major storage site for glycogen, iron, copper, fat soluble vitamins A, D, E, K, and vitamin B12. The liver also plays a central role in the detoxification and excretion of waste productions, including ammonia, bacteria, bilirubin, and medications. Unfortunately, PCM is frequently underdiagnosed in patients with ESLD. 1