Metabolic-Dysfunction-Associated Steatotic Liver Disease at the Forefront: Confronting Nutritional Obstacles in Advanced Chronic Liver Disease and Portal Hypertension

Dear Colleagues,

In the realm of clinical nutrition for patients with advanced chronic liver disease, it is imperative to adopt an individualized and meticulous approach, as recommended by prominent guidelines, such as EASL, ESPEN, and AGA. Beyond focusing solely on etiological therapy, thorough nutritional evaluation and management are crucial components, especially in the context of portal hypertension and its associated complications, such as end-stage liver disease, infectious ailments, sarcopenia, and encephalopathy. Notably, in obese individuals with advanced liver disease, conditions including metabolic-dysfunction-associated steatotic liver disease (MASLD) often lead to the development of sarcopenia and malnutrition, creating a scenario known as “sarcopenic obesity“. This condition not only leads to deterioration in the prognosis of liver cirrhosis by escalating patients’ susceptibility to infections but also diminishes overall survival rates. Additionally, the presence of obesity and malnutrition in cirrhotic patients impairs the technical feasibility of orthotopic liver transplantation.
Expanding upon the outlined topics, the following critical areas warrant in-depth exploration:

• Commercial Diets, Meal Replacements, Vegan Diet, and New Intermittent-Fasting Diets: Applicability and Evidence in Patients with Chronic Liver Disease: The utilization of commercial diets, meal replacements, and emerging intermittent-fasting regimens as potential interventions for managing chronic liver diseases. Submissions exploring the scientific basis and clinical applications of these dietary approaches in the context of advanced chronic liver disease are encouraged.
• Assessment of Sarcopenia and Sarcopenic Obesity in Patients with ACLD: Comprehensive assessment strategies, including imaging modalities, biochemical markers, and physical performance tests, for identifying sarcopenia and sarcopenic obesity in patients afflicted with advanced chronic liver disease. Original research contributions, epidemiological studies, and systematic reviews shedding light on the diagnostic criteria and evaluation methods for these conditions are welcome.
• Association Between Diet and Natural History of ACLD, with regard to Infections and Liver Decompensation: Research investigating the intricate relationship between dietary interventions and the natural disease progression of advanced chronic liver disease, particularly focusing on the impacts on infections and liver decompensation. Original contributions, epidemiological studies, and narrative and systematic reviews, as well as meta-analyses elucidating the association between dietary patterns and the clinical outcomes of patients with ACLD, are encouraged.

We welcome the submission of original research contributions, epidemiological studies, and narrative and systematic reviews, as well as meta-analyses, all shedding light on the interconnected facets of clinical nutrition in patients with advanced chronic liver disease, with a particular focus on MASLD.

Dr. Angelo Armandi
Dr. Federico Ravaioli
Guest Editors

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