Nutrition and Liver Disease

Dear Colleagues,

Malnutrition in children and adults with liver disease is a tremendously challenging issue due to its multifactorial nature, which includes hypermetabolism, increased energy needs, malabsorption, and anorexia. Despite advances in both assessment and management of malnutrition, correct nutritional support is still an often-unanswered need in the care of these patients to avoid poor outcomes.

In general, a central issue remains the regeneration of liver cells of acute liver failure patients or of sarcopenic chronically malnourished hepatopathic patients with end stage liver diseases and cirrhosis, conditions characterized by a subtle border between need for hypercaloric diets rich in proteins and risk of hepatic encephalopathy-hyperammoniemia. In these patients, the need for severe protein restriction, however, may be alleviated by measures, such as lactulose and neomycin or probiotics to decrease intestinal ammoniogenesis and specific aminoacids (branched chain amino acids naturally found in some foods or chemically modified).

Partial substitution of usual fats with medium chain triglycerides, and carefully monitored supplement of fat soluble vitamins is necessary in cholestatic conditions.

In the pediatric age certain inherited metabolic/genetic defects (e.g., galactosemia, tyrosinemia, hereditary fructose intolerance, hyperammoniemia due to IEMs of urea cycle or citrin deficiency, Wilson disease, Congenital defects of glycosilation) which require specific dietary restrictions +/− addition of specific drugs (e.g., Nitisinone in Tyrosinemia; decoppering agents in Wilson Disease ) or special food supplements (e.g., mannose in some CDGs, starch in glycogen storage diseases) represent a further challenge for pediatricians and adult hepatologists at the time of transition of care as well.

A dietician familiar with metabolic disorders may be necessary as many foods contain these toxic ingredients.

Finally, specific challenges are represented by gut-liver axis dysfunction in

• Parenteral Nutrition/ Intestinal Failure
• Inflammatory Bowel Disease; Celiac disease; Cystic Fibrosis

The purpose of this Special Issue, “Nutrition and Liver Disease”, is to provide novel information and perspectives in the field of nutrition in liver disease and its management.

The topics covered should include among others:

• Assessment and management of malnutrition in liver disease
• Parenteral Nutrition/Intestinal Failure/Inflammatory Bowel Disease, Celiac disease, Cystic Fibrosis Associated Liver Disease.
• Advances in certain inherited metabolic/genetic defects benefiting from specific dietetic treatment (dietary restrictions or supplements)
• Correct perioperative oral/enteral/parenteral nutrition in chronic liver disease pre-liver transplant.
• Advances in gut-liver axis

Prof. Pietro Vajro
Dr. Claudia Mandato, MD, PhD
Guest Editors

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