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Nutrition Interventions in Liver Cirrhosis and Liver Transplantation

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (20 November 2022) | Viewed by 11691

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Special Issue Editors

Dr. Aldo J. Montano-Loza

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Guest Editor

Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, AB, Canada
Interests: autoimmune liver disease; liver transplantation; end-stage liver disease; nutrition and body composition
Special Issues, Collections and Topics in MDPI journals

Dr. Maryam Ebadi

E-Mail Website
Guest Editor

Division of Gastroenterology & Liver Unit, University of Alberta, Edmonton, AB T6G 2X8, Canada
Interests: body composition; fat metabolism; adipose tissue; nutritional assessment; sarcopenia
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Malnutrition frequently presents in patients with chronic liver diseases and patients awaiting a liver transplant. The presence of malnutrition and/or body composition abnormalities in patients with chronic liver diseases is associated with prolonged hospitalization, adverse outcomes, and incremental healthcare costs. It also negatively impacts the quality of life and the ability to respond to stressors, such as infection and surgery. The etiology of malnutrition in chronic liver diseases is multifactorial, resulting from combined nutritional, metabolic and biochemical disturbances.

Although ensuring adequate calorie and protein intake and physical activity remain the mainstay of therapy for malnutrition in these populations, other plausible nutritional interventions such as growth hormones, insulin-like growth factor, zinc, branched-chain amino acids, antioxidants, long-chain n-3 PUFAs, probiotics and testosterone replacement, among others, might play a therapeutic role in the management of liver diseases to improve patients’ outcomes and quality of life.

The goals of this special section are to describe the impact of nutrition counselling and nutritional supplements on the outcomes of patients with liver diseases, indicate the nutritional interventions that might affect the severity and outcome of patients with chronic liver disease and liver transplant candidates, and examine the implications of interventions and the investigational opportunities that might improve its management. Contributions, either as an original manuscript or review article, from researchers across multiple disciplines are welcomed.

Prof. Dr. Aldo J. Montano-Loza
Dr. Maryam Ebadi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

nutritional intervention
protein- and energy-rich supplements
oral nutritional supplements
parenteral/enteral nutrition
supplemental nutrition
alcoholic and nonalcoholic steatohepatitis
liver cirrhosis
liver transplantation
chronic liver disease
micronutrient deficiencies

Published Papers (4 papers)

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Research

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13 pages, 784 KiB

Open AccessFeature PaperArticle

Prognostic Significance of Severe Vitamin D Deficiency in Patients with Primary Sclerosing Cholangitis

by Maryam Ebadi, Elora Rider, Catherine Tsai, Sarah Wang, Ellina Lytvyak, Andrew Mason and Aldo J. Montano-Loza

Nutrients 2023, 15(3), 576; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15030576 - 22 Jan 2023

Cited by 3 | Viewed by 1868

Abstract

Vitamin D deficiency has been linked with adverse events in various liver diseases. The present study aimed to recognize the association between severe vitamin D deficiency and disease progression, hepatobiliary malignancies, liver-related mortality, and the need for liver transplantation in primary sclerosing cholangitis (PSC). Patients with a diagnosis of PSC (n = 354), followed by the autoimmune liver disease clinic at the University of Alberta, were included. Patients with vitamin D levels < 25 nmol/L were defined as severely deficient. Univariate and multivariate analyses were conducted using the Cox proportional hazards regression models. The mean vitamin D level was 59 ± 2 nmol/L, and 63 patients (18%) had a severe vitamin D deficiency. Patients with a severe vitamin D deficiency were 2.5 times more likely to experience hepatobiliary malignancies (HR 2.55, 95% CI, 1.02–6.40, p = 0.046). A severe vitamin D deficiency at diagnosis (HR 1.82, 95% CI, 1.05–3.15, p = 0.03) and persistent deficiencies over time (HR 2.26, 95% CI, 1.17–4.37, p = 0.02) were independently associated with a higher risk of poor clinical liver outcomes. A severe vitamin D deficiency at diagnosis and persistent deficiency at longitudinal assessments were associated with liver-related mortality or the need for liver transplantation. Full article

(This article belongs to the Special Issue Nutrition Interventions in Liver Cirrhosis and Liver Transplantation)

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12 pages, 433 KiB

Open AccessArticle

Effects of Calorie Restricted Diet on Oxidative/Antioxidative Status Biomarkers and Serum Fibroblast Growth Factor 21 Levels in Nonalcoholic Fatty Liver Disease Patients: A Randomized, Controlled Clinical Trial

by Somayyeh Asghari, Mahsa Rezaei, Maryam Rafraf, Mahdiyeh Taghizadeh, Mohammad Asghari-Jafarabadi and Maryam Ebadi

Nutrients 2022, 14(12), 2509; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14122509 - 16 Jun 2022

Cited by 11 | Viewed by 2293

Abstract

Oxidative stress plays a fundamental role in the development and progression of nonalcoholic fatty liver disease (NAFLD). This study aimed to investigate the effects of a calorie-restricted (CR) diet on oxidative/anti-oxidative status in patients with NAFLD and the potential mediating role of fibroblast growth factor 21 (FGF-21) in this regard. This randomized, controlled clinical trial was carried out on sixty patients with NAFLD aged 20 to 60 years with body mass index (BMI) ranging from 25 to 35 kg/m². Participants were randomly assigned to either the CR diet group (received a prescribed low-calorie diet for twelve weeks, n = 30) or the control group (n = 30). Fasting blood samples, anthropometric measurements, dietary intake, and physical activity data were collected for all participants at baseline and at the end of the trial. Significant reductions in weight, BMI, waist circumference, and serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were observed in the CR diet group compared to the control group (all p < 0.05). Liver steatosis grade, serum levels of malondialdehyde (MDA), total antioxidant capacity (TAC), and FGF-21, as well as erythrocyte superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activities did not show significant changes in the CR group when compared to the controls at the end of the study (p > 0.05). CR diet with moderate weight loss has some favorable effects on NAFLD but was not able to modify oxidative/anti-oxidative status in these patients. Future studies are warranted to target the effects of long-term interventions with a greater weight loss in this patient population. Full article

(This article belongs to the Special Issue Nutrition Interventions in Liver Cirrhosis and Liver Transplantation)

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Review

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33 pages, 1223 KiB

Open AccessReview

Nutritional Strategies to Manage Malnutrition and Sarcopenia following Liver Transplantation: A Narrative Review

by Amal Trigui, Christopher F. Rose and Chantal Bémeur

Nutrients 2023, 15(4), 903; https://0-doi-org.brum.beds.ac.uk/10.3390/nu15040903 - 10 Feb 2023

Cited by 3 | Viewed by 2353

Abstract

Persisting or newly developed malnutrition and sarcopenia after liver transplant (LT) are correlated with adverse health outcomes. This narrative review aims to examine the literature regarding nutrition strategies to manage malnutrition and sarcopenia after LT. The secondary aims are to provide an overview of the effect of nutrition strategies on the incidence of infections, hospital length of stay (LOS), acute cellular rejection (ACR), and mortality after LT. Four databases were searched. A total of 25 studies, mostly of mid–high quality, were included. Six studies found a beneficial effect on nutritional parameters using branched-chain amino acids (BCAA), immunomodulating diet (IMD), or enteral nutrition (EN) whereas two studies using beta-hydroxy-beta-methylbutyrate (HMB) found a beneficial effect on muscle mass and function. Fourteen studies using pre- or pro-biotics, IMD, and EN were effective in lowering infection and six studies using IMD, BCAA or HMB reported reduced hospital LOS. Finally, four studies using HMB and vitamin D were effective in reducing ACR and one study reported reduced mortality using vitamin D after LT. In conclusion, nutritional intervention after LT has different beneficial effects on malnutrition, sarcopenia, and other advert outcomes. Additional large and well-constructed RCTs using validated tools to assess nutritional status and sarcopenia are warranted to ensure more robust conclusions. Full article

(This article belongs to the Special Issue Nutrition Interventions in Liver Cirrhosis and Liver Transplantation)

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Other

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28 pages, 1537 KiB

Open AccessSystematic Review

The Effect of Diet and Exercise Interventions on Body Composition in Liver Cirrhosis: A Systematic Review

by Heidi E. Johnston, Tahnie G. Takefala, Jaimon T. Kelly, Shelley E. Keating, Jeff S. Coombes, Graeme A. Macdonald, Ingrid J. Hickman and Hannah L. Mayr

Nutrients 2022, 14(16), 3365; https://0-doi-org.brum.beds.ac.uk/10.3390/nu14163365 - 17 Aug 2022

Cited by 11 | Viewed by 4176

Abstract

Alterations in body composition, in particular sarcopenia and sarcopenic obesity, are complications of liver cirrhosis associated with adverse outcomes. This systematic review aimed to evaluate the effect of diet and/or exercise interventions on body composition (muscle or fat) in adults with cirrhosis. Five databases were searched from inception to November 2021. Controlled trials of diet and/or exercise reporting at least one body composition measure were included. Single-arm interventions were included if guideline-recommended measures were used (computed tomography/magnetic resonance imaging, dual-energy X-ray absorptiometry, bioelectrical impedance analysis, or ultrasound). A total of 22 controlled trials and 5 single-arm interventions were included. Study quality varied (moderate to high risk of bias), mainly due to lack of blinding. Generally, sample sizes were small (n = 6–120). Only one study targeted weight loss in an overweight population. When guideline-recommended measures of body composition were used, the largest improvements occurred with combined diet and exercise interventions. These mostly employed high protein diets with aerobic and or resistance exercises for at least 8 weeks. Benefits were also observed with supplementary branched-chain amino acids. While body composition in cirrhosis may improve with diet and exercise prescription, suitably powered RCTs of combined interventions, targeting overweight/obese populations, and using guideline-recommended body composition measures are needed to clarify if sarcopenia/sarcopenic obesity is modifiable in patients with cirrhosis. Full article

(This article belongs to the Special Issue Nutrition Interventions in Liver Cirrhosis and Liver Transplantation)

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