Volume 86 - 2023 - Fasc.2 - Reviews
Diet and non-alcoholic fatty liver disease, a short narrative review
The growing importance of non-alcoholic fatty liver disease (NAFLD), the biggest non-communicable liver disease, inherently leads to an increased attention to lifestyle and diet that are closely intertwined with NAFLD. Elements of the Western diet such as saturated fats and carbohydrates and thus soft drinks, red meat and ultra-processed foods are linked to NAFLD. Contrarily, diets rich in nuts, fruits, vegetables and unsaturated fats as seen in the Mediterranean diet are linked to less prevalent and less severe NAFLD. In the absence of approved medical therapy for NAFLD, therapy mostly focusses on lifestyle and diet. This short review tries to provide a succinct overview of the current knowledge on the influence of certain diets or individual nutrients on NAFLD and discusses different dietary approaches. It ends with a short list of recommendations that can be used in daily practice.
Liver health and the interplay between obesity, alcohol and bariatric surgery
The prevalence of obesity and metabolic consequences,
including non-alcoholic fatty liver disease (NAFLD) has become
a global health problem. Obesity has an important impact on
chronic liver disease even beyond NAFLD, as it accelerates the
progression of alcohol liver disease. Conversely, even moderate
alcohol use can affect NAFLD disease severity. Weight loss is the
gold standard treatment but adherence to lifestyle changes is very
low in the clinical setting. Bariatric surgery can improve metabolic
components and cause long-term weight loss. Therefore, bariatric
surgery could serve as an attractive treatment option for NAFLD
patients. A pitfall is the use of alcohol after bariatric surgery. This
short review integrates data about the influence of obesity and
alcohol on liver function and the role of bariatric surgery.
Nutritional status in hepatic encephalopathy and transjugular intrahepatic portosystemic shunt – TIPS, and strategies to improve the outcomes
Hepatic encephalopathy (HE) is one of the most severe complications following transjugular intrahepatic portosystemic shunt (TIPS). The identification and treatment of risk factors associated with the development of this complication may reduce the incidence and severity of post-TIPS HE. Several studies have demonstrated that the nutritional status plays a major role in the outcome of the cirrhotic population, particularly those who are decompensated. Although scarce, there are also studies highlighting an association between poor nutritional status, sarcopenia, fragile status, and post-TIPS HE. If these data are confirmed, nutritional support could become a means for decreasing this complication, thereby enhancing the use of TIPs in the treatment of refractory ascites or variceal bleeding. In this review, we will discuss the pathogenesis of HE, the data that supports an association with sarcopenia, nutritional status and frailty and the implications that these conditions have on the use of TIPS in clinical practice.
Sarcopenia in end-stage liver disease and after liver transplantation
Sarcopenia occurs in 30-70% of patients with end-stage liver
disease and is associated with inferior pre- and post-liver transplant
outcomes such as prolonged intubation times, long intensive care
and hospitalization times, heightened risk of post-transplant
infection, reduced health-related quality of life, and increased rates
of mortality. The pathogenesis of sarcopenia is multifactorial and
involves biochemical disturbances such as hyperammonemia, low
serum concentrations of branched-chain amino acids (BCAAs) and
low serum levels of testosterone, as well as chronic inflammation,
inadequate nutritional status, and physical inactivity. Prompt
recognition and accurate assessment of sarcopenia are critical and
require imaging, dynamometry, and physical performance testing
for the assessment of its subcomponents: muscle mass, muscle
strength, and muscle function, respectively. Liver transplantation
mostly fails to reverse sarcopenia in sarcopenic patients. In fact,
some patients develop de novo sarcopenia after undergoing liver
transplantation. The recommended treatment of sarcopenia is
multimodal and includes a combination of exercise therapy and
complementary nutritional interventions. Additionally, new
pharmacological agents (e.g. myostatin inhibitors, testosterone
supplements, and ammonia-lowering therapy) are under
investigation in preclinical studies. Here, we present a narrative
review of the definition, assessment, and management of sarcopenia
in patients with end-stage liver disease prior to and after liver
transplantation.
Nutritional optimization in liver transplant patients: from the pre-transplant setting to post-transplant outcome
Background and study aims: malnutrition and its clinical
phenotypes, sarcopenia, and frailty, are prevalent conditions that
affect patients with cirrhosis awaiting liver transplantation. The
link between malnutrition, sarcopenia, and frailty and a higher risk
of complications or death (before and after liver transplantation) is
well established. Accordingly, the optimization of nutritional status
could optimize both access to liver transplantation and the outcome
following the surgery. Whether optimization of nutritional status
in patients awaiting LT is associated with improved outcomes
after transplant is the focus of this review. This includes the use
of specialized regimens such as immune-enhancing or branchedchain
amino-acids-enhanced diets.
Results and conclusion: we discuss here the results of the few
available studies in the field and provide an expert opinion of the
obstacles that have led, so far, to an absence of benefit of such
specialized regimens as compared to standard nutritional support.
In the next future, combining nutritional optimization with
exercise and enhanced recovery after surgery (ERAS) protocols
could help optimize outcomes following liver transplantation.
