Is weight gain beneficial for patients with cirrhosis (liver scarring)?

From the Guidelines

Weight gain can be beneficial for patients with cirrhosis, but it depends on their nutritional status, and the primary goal should be to provide adequate nutrition to support liver function and overall health, rather than solely focusing on weight gain. For malnourished patients with cirrhosis, controlled weight gain is recommended to improve muscle mass and overall nutritional status, which can enhance liver function and survival outcomes, as supported by the 2021 practice guidance by the American Association for the Study of Liver Diseases 1.

Key Considerations

• A high-protein diet of 1.2-1.5 g/kg/day is typically advised, with small, frequent meals throughout the day to improve nutrient absorption, as recommended in the 2021 practice guidance 1.
• Patients with cirrhosis should focus on consuming adequate calories (30-35 kcal/kg/day), emphasizing lean proteins, complex carbohydrates, and healthy fats while limiting sodium to 2,000 mg daily to manage ascites.
• Branched-chain amino acid supplements may not be necessary for all patients, as standard ICU protein support is indicated, with higher protein requirements recommended in malnourished patients with acute-on-chronic liver failure (ACLF), according to the 2024 AASLD practice guidance on ACLF and the management of critically ill patients with cirrhosis 1.
• Regular nutritional assessment by healthcare providers is essential to determine appropriate weight management goals and to identify patients who may benefit from early nutrition support, as recommended by the Society of Critical Care Medicine/American Society for Parenteral and Enteral Nutrition guidelines 1.

Nutrition Support Goals

• Energy and protein requirements for nutrition support are calculated by predictive equation initially, using dry weight or ideal body weight instead of actual body weight, with a target caloric goal of 35 kcal/kg for patients without obesity with cirrhosis and 25–35 kcal/kg for patients with obesity with a body mass index of 30–40, as recommended in the 2021 AASLD Practice Guidance on Malnutrition, Frailty, and Sarcopenia 1.
• Indirect calorimetry to measure resting energy expenditure should be used if available for more accurate assessment, and enteral nutrition with a feeding tube may be needed for those requiring invasive ventilation for acute respiratory distress syndrome or other respiratory conditions, as stated in the 2024 AASLD practice guidance on ACLF and the management of critically ill patients with cirrhosis 1.

Conclusion is not allowed, so the answer will be ended here.

From the Research

Weight Gain in Cirrhosis Patients

• Weight gain is not necessarily beneficial for patients with cirrhosis, as it can be associated with an increased risk of complications such as portal hypertension and liver transplantation difficulties 2.
• Malnutrition is a prevalent complication in cirrhosis patients, and nutritional assessment is crucial to identify and address macro- and micronutrient deficiencies 3.
• The goals of nutritional assessment in cirrhosis include identifying and describing the challenges associated with nutritional assessment and describing recent advancements in clinical, laboratory, and instrumental tools 3.

Nutritional Assessment and Intervention

• Nutritional assessment methods have been developed in recent years, and tools such as bioelectrical impedance analysis and computed tomography transverse images can be helpful in evaluating malnourished patients with liver diseases 3.
• Patient-perceived barriers to lifestyle interventions, including adequate nutritional intake and physical activity, are common in cirrhosis patients and should be evaluated and treated in all patients 4.
• Educational interventions can improve nutritional consultation rates in inpatients with cirrhosis, which is associated with lower 90-day readmission rates 5.

Complications and Prognosis

• Malnutrition can worsen the prognosis of cirrhosis, and nutritional assessment and intervention are essential to improve outcomes 6, 5.
• Sarcopenia, muscle weakness, and physical frailty are independent predictors of mortality in cirrhosis, and lifestyle interventions can potentially modify these adverse prognostic factors 4.
• Weight gain, particularly in the form of obesity, can negatively affect the prognosis of cirrhosis and make liver transplantation more difficult 2.