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Alcoholic Liver Disease and Malnutrition

Authors

  • Craig J. McClain,

    1. From the Department of Medicine (CJM, SSB, AB, LM), Department of Pharmacology and Toxicology (CJM, SSB), University of Louisville School of Medicine, Louisville, Kentucky; Alcohol Research Center (CJM, SSB, AB, LM), University of Louisville, Louisville, Kentucky; Louisville VAMC (CJM, AB, LM), Louisville, Kentucky.
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  • Shirish S. Barve,

    1. From the Department of Medicine (CJM, SSB, AB, LM), Department of Pharmacology and Toxicology (CJM, SSB), University of Louisville School of Medicine, Louisville, Kentucky; Alcohol Research Center (CJM, SSB, AB, LM), University of Louisville, Louisville, Kentucky; Louisville VAMC (CJM, AB, LM), Louisville, Kentucky.
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  • Ashutosh Barve,

    1. From the Department of Medicine (CJM, SSB, AB, LM), Department of Pharmacology and Toxicology (CJM, SSB), University of Louisville School of Medicine, Louisville, Kentucky; Alcohol Research Center (CJM, SSB, AB, LM), University of Louisville, Louisville, Kentucky; Louisville VAMC (CJM, AB, LM), Louisville, Kentucky.
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  • Luis Marsano

    1. From the Department of Medicine (CJM, SSB, AB, LM), Department of Pharmacology and Toxicology (CJM, SSB), University of Louisville School of Medicine, Louisville, Kentucky; Alcohol Research Center (CJM, SSB, AB, LM), University of Louisville, Louisville, Kentucky; Louisville VAMC (CJM, AB, LM), Louisville, Kentucky.
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Reprint requests: Craig J. McClain, MD, Division of Gastroenterology, Hepatology and Nutrition, University of Louisville School of Medicine, Clinical and Translational Research Building, 505 South Hancock Street, Room 503, Louisville, KY 40292; Tel.: +1-502-852-6189; Fax: +1-502-852-8927; E-mail: cjmccl01@gwise.louisville.edu

Abstract

Malnutrition, both protein energy malnutrition (PEM) and deficiencies in individual nutrients, is a frequent complication of alcoholic liver disease (ALD). Severity of malnutrition correlates with severity of ALD. Malnutrition also occurs in patients with cirrhosis due to etiologies other than alcohol. The mechanisms for malnutrition are multifactorial, and malnutrition frequently worsens in the hospital due to fasting for procedures and metabolic complications of liver disease, such as hepatic encephalopathy. Aggressive nutritional support is indicated in inpatients with ALD, and patients often need to be fed through an enteral feeding tube to achieve protein and calorie goals. Enteral nutritional support clearly improves nutrition status and may improve clinical outcome. Moreover, late-night snacks in outpatient cirrhotics improve nutritional status and lean body mass. Thus, with no FDA-approved therapy for ALD, careful nutritional intervention should be considered as frontline therapy.

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