Optimizing nutrition in hepatic cirrhosis:A comprehensive assessment and care approach

Cirrhosis is considered a growing cause of morbidity and mortality,which represents a significant public health problem.Currently,there is no effective treatment to reverse cirrhosis.Treatment primarily centers on addressing the underlying liver condition,monitoring,and managing portal hypertension-related complications,and evaluating the potential for liver transplantation in cases of decompensated cirrhosis,marked by rapid progression and the emer-gence of complications like variceal bleeding,hepatic encephalopathy,ascites,malnutrition,and more.Malnutrition,a prevalent complication across all disease stages,is often underdiagnosed in cirrhosis due to the complexities of nutritional assessment in patients with fluid retention and/or obesity,despite its crucial impact on prognosis.Increasing emphasis has been placed on the collaboration of nutritionists within hepatology and Liver transplant teams to deliver compre-hensive care,a practice that has shown to improve outcomes.This review covers appropriate screening and assessment methods for evaluating the nutritional status of this population,diagnostic approaches for malnutrition,and context-specific nutrition treatments.It also discusses evidence-based recommendations for supplementation and physical exercise,both essential elements of the standard care provided to cirrhotic patients.

Higher cardiovascular risk scores and liver fibrosis risk estimated by biomarkers in patients with metabolic-dysfunction-associated fatty liver disease

BACKGROUND The definition of metabolic-dysfunction-associated fatty liver disease(MAFLD)allows identification of metabolically complicated patients.Fibrosis risk scores are related to cardiovascular risk(CVR)scores and could be useful for the identification of patients at risk of systemic complications.AIM To evaluate the relationship between MAFLD and CVR using the Framingham risk score in a group of Mexican patients.METHODS Cross-sectional,observational and descriptive study carried out in a cohort of 585 volunteers in the state of Veracruz with MAFLD criteria.The risk of liver fibrosis was calculated with aspartate aminotransferase-to-platelet ratio index,nonalcoholic fatty liver disease score and fibrosis-4,as well as with transient hepatic elastography with Fibroscan~?.The CVR was determined by the Framingham system.RESULTS One hundred and twenty-five participants(21.4%)with MAFLD criteria were evaluated,average age 54.4 years,63.2%were women,body mass index 32.3 kg/m~2.The Framingham CVR was high in 43 patients(33.9%).Transient elastography was performed in 55.2%of volunteers;39.1%with high CVR and predominance in advanced fibrosis(F3–F4).The logistic regression analysis showed that liver fibrosis,diabetes and hypertension independently increased CVR.CONCLUSION One of every three patients with MAFLD had a high CVR,and in those with high fibrosis risk,the CVR risk was even greater.