From the Guidelines
Weight loss is generally not beneficial for patients with cirrhosis and may actually be harmful. Patients with cirrhosis should focus on maintaining adequate nutrition rather than losing weight, even if they are overweight. Unintentional weight loss in cirrhosis is concerning and associated with worse outcomes. Malnutrition is common in cirrhosis and can lead to complications including muscle wasting (sarcopenia), which increases mortality risk. Instead of weight loss, cirrhosis patients 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. For patients with both obesity and cirrhosis, any weight management should be done very gradually under close medical supervision, focusing on improving metabolic health rather than rapid weight reduction. This cautious approach is necessary because the liver's reduced function in cirrhosis impairs the body's ability to mobilize and process nutrients during periods of caloric restriction 1.
Key Considerations
- Malnutrition and sarcopenia are prevalent in cirrhosis and associated with poor outcomes, including increased mortality risk 1.
- A high-protein diet with adequate calories is recommended to prevent muscle loss and support overall health 1.
- Enteral nutrition is preferred over parenteral nutrition in critically ill patients with cirrhosis, with the goal of providing 35 kcal/kg/day and 1.2-1.5 g/kg/day of protein 1.
- Moderate weight reduction may be suggested for patients with compensated cirrhosis and obesity, but this should be done under close medical supervision and with a focus on maintaining muscle mass 1.
Nutrition Recommendations
- Protein intake: 1.2-1.5 g/kg/day
- Caloric intake: 30-35 kcal/kg/day
- Sodium restriction: 2000 mg/day if fluid retention is present
- Frequent small meals and a late evening snack to prevent muscle breakdown
- Consultation with a registered dietician or nutrition support team for personalized guidance 1.
From the Research
Weight Loss and Cirrhosis
- Weight loss can be beneficial for patients with cirrhosis, particularly those who are morbidly obese, as it can improve their eligibility for liver transplantation and reduce the risk of complications 2.
- However, weight loss interventions should be carefully considered and monitored in patients with cirrhosis, as they can also lead to malnutrition and worsening of liver function 3.
- A study found that Roux-en-Y gastric bypass (RYGB) allows patients to lose more weight more rapidly than adjustable gastric banding (AGB) or diet and exercise, resulting in a greater impact on survival in morbidly obese patients with compensated cirrhosis 2.
Nutritional Considerations
- Patients with cirrhosis tend to be hypermetabolic and require a higher-than-normal supply of dietary proteins to achieve nitrogen balance 4.
- A modified eating pattern, based on several meals and a late evening snack, can be useful for patients with cirrhosis 4.
- Nutritional assessment and consultation can significantly improve outcomes in patients with cirrhosis, including reducing 90-day readmission rates 5.
Treatment Options
- Bariatric surgery, such as RYGB, can be an effective treatment option for morbidly obese patients with compensated cirrhosis 2, 3.
- Endoscopic interventions for obesity are emerging as a promising option for patients with cirrhosis, as they are minimally invasive 3.
- Branched-chain amino acid (BCAA) supplements can be beneficial for patients with cirrhosis, particularly those with impaired protein metabolism and hepatic encephalopathy 4, 6.