What diet is recommended for patients with cirrhosis?

From the Guidelines

Patients with cirrhosis should receive personalized dietary counseling to optimize their nutritional status, with a recommended protein intake of 1.2-1.5 g/kg ideal body weight per day and calorie needs tailored to the individual patient, as stated in the 2021 practice guidance by the American Association for the Study of Liver Diseases 1. The goal of dietary management in cirrhosis is to prevent malnutrition, which is associated with increased morbidity and mortality.

• Key components of the diet include:
  • Personalized calorie intake, with a target of at least 35 kcal/kg body weight/day for non-obese individuals and 25-35 kcal/kg/day for obese individuals 1
  • Protein intake of 1.2-1.5 g/kg ideal body weight per day, with a diverse range of protein sources encouraged 1
  • Minimizing fasting time, with a maximum interval of 3-4 hours between nutritional intake while awake, and an early breakfast and/or late-evening snack recommended 1
• It is also important to consider the individual patient's needs and habits when developing a dietary plan, as stated in the 2021 practice guidance by the American Association for the Study of Liver Diseases 1.
• The European Society for Clinical Nutrition and Metabolism (ESPEN) also recommends a personalized approach to nutrition in liver disease, with a focus on adequate protein and calorie intake, as well as supplementation with branched-chain amino acids (BCAAs) in certain cases 1.
• Overall, the most recent and highest quality evidence supports a personalized and tailored approach to dietary management in cirrhosis, with a focus on optimizing nutritional status and preventing malnutrition 1.

From the Research

Diet Recommendations for Cirrhosis

• A high energy, high protein diet is recommended for patients with cirrhosis 2
• Daily protein requirements for patients with cirrhosis are higher than those of healthy individuals, and previous recommendations that limited protein intake should no longer be practiced 3
• Higher intakes of branched-chain amino acids as well as vegetable proteins have shown benefits in patients with cirrhosis 3, 4
• Sodium restrictions are necessary to prevent ascites development, but very strict limitations should be avoided to prevent protein-calorie malnutrition (PCM) 3

Nutritional Assessment and Factors Affecting Dietary Intake

• Malnutrition is a common feature of terminal chronic liver disease and is predictor of morbidity and mortality in patients with cirrhosis 5, 6
• Factors affecting dietary intake in patients with cirrhosis include poor appetite, early satiety, abdominal fullness, low-salt diet, and social myth about diet 6
• Distension of abdomen, social myth about diet, and low sodium in diet are key factors affecting dietary intake in patients with cirrhosis and malnutrition 6

Specific Dietary Recommendations

• The European Society for Clinical Nutrition and Metabolism (ESPEN) recommends a caloric intake of 30-40kcal/kg/day, with carbohydrates providing 45-60% of the daily energy intake and proteins supplying 1.0-1.5g/kg/day 4
• Branched-chain amino acids should be considered part of nutritional treatment in patients with advanced stages of cirrhosis of the liver, particularly in the presence of complications 4