[Nutritional support in patients with liver cirrhosis]

Current Medical Treatment for Alcohol-Associated Liver Disease

Alcohol-associated liver disease is one of the main causes of chronic liver disease. It comprises a clinical-histologic spectrum of presentations, from steatosis, steatohepatitis, to different degrees of fibrosis, including cirrhosis and severe necroinflammatory disease, called alcohol-associated hepatitis. In this focused update, we aim to present specific therapeutic interventions and strategies for the management of alcohol-associated liver disease. Current evidence for management in all spectra of manifestations is derived from general chronic liver disease recommendations, but with a higher emphasis on abstinence and nutritional support. Abstinence should comprise the treatment of alcohol use disorder as well as withdrawal syndrome. Nutritional assessment should also consider the presence of sarcopenia and its clinical manifestation, frailty. The degree of compensation of the disease should be evaluated, and complications, actively sought. The most severe acute form of this disease is alcohol-associated hepatitis, which has high mortality and morbidity. Current treatment is based on corticosteroids that act by reducing immune activation and blocking cytotoxicity and inflammation pathways. Other aspects of treatment include preventing and treating hepatorenal syndrome as well as preventing infections although there is no clear evidence as to the benefit of probiotics and antibiotics in prophylaxis. Novel therapies for alcohol-associated hepatitis include metadoxine, interleukin-22 analogs, and interleukin-1-beta antagonists. Finally, granulocyte colony-stimulating factor, microbiota transplantation, and gut-liver axis modulation have shown promising results. We also discuss palliative care in advanced alcohol-associated liver disease.

Frailty, Sarcopenia, and Malnutrition in Cirrhotic Patients

Sarcopenia, frailty, and malnutrition are prevalent complications in patients with end-stage liver disease (ESLD) and are associated with increased risk of morbidity and mortality. It is valuable to measure nutritional status, sarcopenia, and frailty over time in order to create interventions tailored to individuals with ESLD. Evaluating sarcopenia and frailty in patients with ESLD is challenging. Further work is needed to perfect these assessments so that clinicians can incorporate these assessments into their decision-making and management plans for cirrhotic patients.

Nutrition in Chronic Liver Disease

Protein-calorie malnutrition is a transversal condition to all stages of chronic liver disease. Early recognition of micro or macronutrient deficiencies is essential, because the use of nutritional supplements reduces the risk of complications. The diet of patients with chronic liver disease is based on a standard diet with supplements addition as necessary. Restrictions may be harmful and should be individualized. Treatment management should aim to maintain an adequate protein and caloric intake and to correct nutrient deficiencies. The large majority of patients with grade I/II hepatic encephalopathy can tolerate a regular diet. Protein restriction can aggravate malnutrition and is not recommended, except in cases of hepatic encephalopathy unresponsive to optimized therapy.

Effect of compound azintamide enteric-coated tablet combined with compound nutrients (Noveliver) on serum albumin and pre-albumin levels in patients with decompensated liver cirrhosis

AIM: To observe the effect of compound azintamide enteric-coated tablet combined with compound nutrients (Noveliver) on serum albumin (ALB) and pre-albumin (PA) levels in patients with decompensated liver cirrhosis.

METHODS: A total of 35 inpatients with decompensated liver cirrhosis were enrolled in this trial, including 20 patients treated with compound azintamide enteric-coated tablet combined with compound nutrients (Noveliver) plus routine medical treatment, and 15 patients receiving routine medical treatment only as controls. The efficacy of compound azintamide enteric-coated tablet combined with compound nutrients (Noveliver) was monitored during a 12-week follow-up period.

RESULTS: After treatment with compound azintamide enteric-coated tablet combined with compound nutrients (Noveliver), serum PA and ALB levels increased gradually. PA levels at 4 wk after treatment were 110.3 mg/L ± 14.6 mg/L vs 100.8 mg/L ± 7.5 mg/L (P < 0.05) in the treatment group and control group. ALB levels at 8 wk after treatment and 31.9 g/L ± 2.5 g/L vs 29.8 g/L ± 2.1 g/L (P < 0.05) in the treatment group and control group. The efficacy continued to 12 wk after treatment.

CONCLUSION: Compound azintamide enteric-coated tablet combined with compound nutrients (Noveliver) improves the nutritional status of patients with decompensated cirrhosis, increases serum ALB and PA levels, and reduces the incidence and severity of ascites.