Assistance nutritionnelle au cours des insuffisances hépatocellulaires

Protein energy malnutrition is particularly frequent and severe in cirrhotic patients and may be determined by the routine measure of the mid-arm muscle circumference. The reasons for malnutrition include various factors such as anorexia, poor diet, and altered metabolic state. When the patient is hospitalized, malnutrition is frequently worsened due to the test-related necessity of fasting, continued anorexia, and complications such as gastrointestinal bleeding. Dietetic recommendations must be done to all patients. In cirrhotic patients energy needs are about 30 to 35 kcal/d with 1.2 to 1.5 g/d of protein. Oral supplementation with vitamins is often mandatory. Many studies have now clearly demonstrated that in malnourished patients nutrition support may improve outcome. In case of moderate malnutrition oral supplement enriched with branched chain amino acids may be useful. In case of severe malnutrition in hospitalized patients, enteral nutrition may be considered. Peri-operative nutrition support should be considered before surgery for hepatocellular carcinoma or liver transplantation.