title: Diagnosis and treatment of nutritional deficiencies in alcoholic liver disease: Overview of available evidence and open issues.
abstract: Malnutrition is common in alcoholic liver disease and is associated with high rates of complications and mortality. In this article, the current literature was reviewed to highlight the relevance of proper nutritional management providing levels of evidence, when available. A PubMed search was performed for English-language publications from 1980 through 2014 with the keywords: alcoholic liver disease, nutritional deficiencies, nutritional support, enteral nutrition, parenteral nutrition, and protein-energy malnutrition. Manuscripts focused on nutritional approach in patients with alcoholic liver disease were selected. Although nutritional support for malnourished patients improves the outcome of hospitalization, surgery, transplantation and reduces the complications of liver disease and the length of hospital stay, specific guidelines are scanty. Both enteral and parenteral nutrition appear to improve nutritional parameters and liver function; however data on survival is often conflicting. As micronutrient depletion is common in alcoholic liver disease and each deficiency produces specific sequelae, all cirrhotic patients should be screened at baseline for deficiencies of micronutrient and supplemented as needed. In summary, protein-energy malnutrition and micronutrient depletion are clinical concerns in alcoholic liver disease. Nutritional therapy, including enteral nutrition, parenteral nutrition and micronutrient supplementation should be part of the multidisciplinary management of these patients.
authors.affiliation: Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy. Electronic address: robertaelisa.rossi@gmail.com.
authors.forename: Roberta Elisa
authors.initials: RE
authors.lastname: Rossi
authors.affiliation: Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Italy; Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Conte
authors.affiliation: Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Massironi
mesh_terms: D004750:Enteral Nutrition; D006801:Humans; D007902:Length of Stay; D008108:Liver Diseases, Alcoholic / Q000150:complications*; D044342:Malnutrition / Q000175:diagnosis / Q000628:therapy*; D018977:Micronutrients / Q000627:therapeutic use*; D018529:Nutritional Support; D010288:Parenteral Nutrition; D012720:Severity of Illness Index
chemical_list: D018977:Micronutrients
keywords: Alcoholic liver disease; Enteral nutrition; Nutritional deficiencies; Nutritional support; Parenteral nutrition; Protein–energy malnutrition