From the Guidelines
Weight loss can be beneficial for patients with cirrhosis, but it should be approached with caution and individualized based on the patient's condition and nutritional status. The most recent and highest quality study, 1, suggests that weight loss should be an important therapeutic goal for obese patients with cirrhosis, as obesity is a major risk factor for hepatic decompensation, portal vein thrombosis, hepatocellular carcinoma, and the development of acute on chronic liver disease. However, the method and rapidity of weight loss should be individualized and dependent on factors such as BMI, presence and degree of sarcopenia, edema/ascites, and patient age.
Key Considerations
- Weight management, ideally ≥10% total body weight loss, via lifestyle modification may decrease portal hypertension and histologic progression, but success in implementing these interventions in clinical practice and uncertainties regarding durability of this approach limit the utility of this method for treatment of obese patients with cirrhosis 1.
- Bariatric surgery should be considered in selected patients with compensated cirrhosis in an effort to reduce risk for hepatocellular carcinoma and improve survival, but it should only be performed in those with compensated disease by an experienced surgeon at a high-volume bariatric center 1.
- A tailored, moderately hypocaloric diet, including adequate protein intake (>1.5 g proteins/kg.BW/d), can be adopted to achieve weight loss without compromising protein stores in obese cirrhotic patients 1.
Nutritional Recommendations
- Patients with cirrhosis should aim for a balanced diet with adequate protein (1.2-1.5 g/kg/day), sufficient calories (30-35 kcal/kg/day), and appropriate sodium restriction (2000 mg/day) if they have fluid retention.
- Small, frequent meals including a late evening snack can help prevent muscle breakdown.
- In cases of obesity with early-stage compensated cirrhosis, very gradual weight loss (no more than 0.5-1 kg/week) under close medical supervision might be considered, but this approach requires careful monitoring of nutritional status and should never be attempted in patients with decompensated cirrhosis.
From the Research
Weight Loss in Cirrhosis Patients
- Weight loss can be beneficial for patients with cirrhosis, particularly those who are obese, as it can improve their prognosis and make liver transplantation more feasible 2.
- However, weight loss during cirrhosis can also be related to the etiology of liver disease, with patients with alcoholic cirrhosis tend to lose more weight than those with other types of liver disease 3.
Nutrition and Cirrhosis
- Malnutrition is a common complication in cirrhosis patients, and it can negatively impact their survival, quality of life, and response to stressors such as infection and surgery 4, 5.
- Sarcopenia, or muscle wasting, is a major component of malnutrition in cirrhosis patients, and it has been associated with increased mortality, sepsis complications, and other adverse clinical consequences 5.
Weight Loss Interventions
- Weight loss interventions, such as Roux-en-Y gastric bypass, adjustable gastric banding, and diet and exercise, can be effective in improving survival in morbidly obese patients with compensated cirrhosis 6.
- However, the safest and most efficacious weight loss regimen for cirrhosis patients is still a topic of debate, and more research is needed to determine the best approach 2, 6.