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A special issue of Nutrients (ISSN 2072-6643).

Deadline for manuscript submissions: closed (15 August 2017) | Viewed by 115225

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Prof. Dr. Pietro Vajro

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Guest Editor

Former Director Pediatrics Section, Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, SA, Italy
Interests: liver; gastroenterology; obesity; children; interplay GI/nutrition and liver disease
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Dr. Claudia Mandato

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Guest Editor

Children’s Hospital Santobono-Pausilipon, 80129 Naples, Italy
Interests: liver diseases; hepatology; fatty liver; insulin resistance; liver transplantation; liver failure; liver diseases and immunology; biliary tract diseases; metabolism
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Malnutrition in children and adults with liver disease is a tremendously challenging issue due to its multifactorial nature, which includes hypermetabolism, increased energy needs, malabsorption, and anorexia. Despite advances in both assessment and management of malnutrition, correct nutritional support is still an often-unanswered need in the care of these patients to avoid poor outcomes.

In general, a central issue remains the regeneration of liver cells of acute liver failure patients or of sarcopenic chronically malnourished hepatopathic patients with end stage liver diseases and cirrhosis, conditions characterized by a subtle border between need for hypercaloric diets rich in proteins and risk of hepatic encephalopathy-hyperammoniemia. In these patients, the need for severe protein restriction, however, may be alleviated by measures, such as lactulose and neomycin or probiotics to decrease intestinal ammoniogenesis and specific aminoacids (branched chain amino acids naturally found in some foods or chemically modified).

Partial substitution of usual fats with medium chain triglycerides, and carefully monitored supplement of fat soluble vitamins is necessary in cholestatic conditions.

In the pediatric age certain inherited metabolic/genetic defects (e.g., galactosemia, tyrosinemia, hereditary fructose intolerance, hyperammoniemia due to IEMs of urea cycle or citrin deficiency, Wilson disease, Congenital defects of glycosilation) which require specific dietary restrictions +/− addition of specific drugs (e.g., Nitisinone in Tyrosinemia; decoppering agents in Wilson Disease ) or special food supplements (e.g., mannose in some CDGs, starch in glycogen storage diseases) represent a further challenge for pediatricians and adult hepatologists at the time of transition of care as well.

A dietician familiar with metabolic disorders may be necessary as many foods contain these toxic ingredients.

Finally, specific challenges are represented by gut-liver axis dysfunction in

Parenteral Nutrition/ Intestinal Failure
Inflammatory Bowel Disease; Celiac disease; Cystic Fibrosis

The purpose of this Special Issue, “Nutrition and Liver Disease”, is to provide novel information and perspectives in the field of nutrition in liver disease and its management.

The topics covered should include among others:

Assessment and management of malnutrition in liver disease
Parenteral Nutrition/Intestinal Failure/Inflammatory Bowel Disease, Celiac disease, Cystic Fibrosis Associated Liver Disease.
Advances in certain inherited metabolic/genetic defects benefiting from specific dietetic treatment (dietary restrictions or supplements)
Correct perioperative oral/enteral/parenteral nutrition in chronic liver disease pre-liver transplant.
Advances in gut-liver axis

Prof. Pietro Vajro
Dr. Claudia Mandato, MD, PhD
Guest Editors

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Keywords

Liver disease
Hepatobiliary disease
Inherited metabolic/genetic liver diseases
Cholestasis
Malnutrition
Parenteral Nutrition, Intestinal Failure
Nutrients
Nutraceuticals
Substrate dietary restriction; Depleted product replenishment; Branched chain amino acids, Mean chain tryglicerides
Inflammatory Bowel Disease; Celiac disease; Cystic Fibrosis

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Published Papers (11 papers)

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Editorial

Jump to: Research, Review

8 pages, 615 KiB

Open AccessEditorial

Nutrition and Liver Disease

by Claudia Mandato, Antonella Di Nuzzi and Pietro Vajro

Nutrients 2018, 10(1), 9; https://doi.org/10.3390/nu10010009 - 23 Dec 2017

Cited by 31 | Viewed by 14725

Abstract

Malnutrition in children and adults with advanced liver disease represents a tremendous challenge as the nutritional problems are multifactorial. This Editorial comments the articles appearing in this special issue of Nutrients, “Nutrition and Liver disease” dealing with multiple diagnostic and therapeutic features that relate the outcomes of liver disease to nutrition. To improve quality of life and prevent nutrition-related medical complications, patients diagnosed with advanced liver disease should have their nutritional status promptly assessed and be supported by appropriate dietary interventions. Furthermore specific food supplements and/or restriction diets are often necessary for those with hepatic conditions associated with an underlying metabolic or nutritional or intestinal disease. Full article

(This article belongs to the Special Issue Nutrition and Liver Disease)

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Research

Jump to: Editorial, Review

10 pages, 1524 KiB

Open AccessArticle

Predictors Associated with Increase in Skeletal Muscle Mass after Sustained Virological Response in Chronic Hepatitis C Treated with Direct Acting Antivirals

by Kazunori Yoh, Hiroki Nishikawa, Hirayuki Enomoto, Akio Ishii, Yoshinori Iwata, Yuho Miyamoto, Noriko Ishii, Yukihisa Yuri, Kunihiro Hasegawa, Chikage Nakano, Takashi Nishimura, Nobuhiro Aizawa, Yoshiyuki Sakai, Naoto Ikeda, Tomoyuki Takashima, Ryo Takata, Hiroko Iijima and Shuhei Nishiguchi

Nutrients 2017, 9(10), 1135; https://doi.org/10.3390/nu9101135 - 18 Oct 2017

Cited by 9 | Viewed by 5228

Abstract

Aims: We aimed to examine changes in skeletal muscle mass in chronic hepatitis C (CHC) patients undergoing interferon (IFN)-free direct acting antivirals (DAAs) therapy who achieved sustained virological response (SVR). Patients and methods: A total of 69 CHC patients treated with DAAs were analyzed. We compared the changes in skeletal muscle index (SMI) using bio-impedance analysis at baseline and SMI at SVR. SMI was calculated as the sum of skeletal muscle mass in upper and lower extremities divided by height squared (cm²/m²). Further, we identified pretreatment parameters contributing to the increased SMI at SVR. Results: SMI in males at baseline ranged from 6.73 to 9.08 cm²/m² (median, 7.65 cm²/m²), while that in females ranged from 4.45 to 7.27 cm²/m² (median, 5.81 cm²/m²). At SVR, 36 patients (52.2%) had increased SMI as compared with baseline. In the univariate analysis, age (p = 0.0392), hyaluronic acid (p = 0.0143), and branched-chain amino acid to tyrosine ratio (BTR) (p = 0.0024) were significant pretreatment factors linked to increased SMI at SVR. In the multivariate analysis, only BTR was an independent predictor linked to the increased SMI at SVR (p = 0.0488). Conclusion: Pretreatment BTR level can be helpful for predicting increased SMI after SVR in CHC patients undergoing IFN-free DAAs therapy. Full article

(This article belongs to the Special Issue Nutrition and Liver Disease)

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10 pages, 680 KiB

Open AccessArticle

Sarcopenia Impairs Prognosis of Patients with Hepatocellular Carcinoma: The Role of Liver Functional Reserve and Tumor-Related Factors in Loss of Skeletal Muscle Volume

by Kenji Imai, Koji Takai, Satoshi Watanabe, Tatsunori Hanai, Atsushi Suetsugu, Makoto Shiraki and Masahito Shimizu

Nutrients 2017, 9(10), 1054; https://doi.org/10.3390/nu9101054 - 22 Sep 2017

Cited by 53 | Viewed by 7003

Abstract

Sarcopenia impairs survival in patients with hepatocellular carcinoma (HCC). This study aimed to clarify the factors that contribute to decreased skeletal muscle volume in patients with HCC. The third lumbar vertebra skeletal muscle index (L3 SMI) in 351 consecutive patients with HCC was calculated to identify sarcopenia. Sarcopenia was defined as an L3 SMI value ≤ 29.0 cm²/m² for women and ≤ 36.0 cm²/m² for men. The factors affecting L3 SMI were analyzed by multiple linear regression analysis and tree-based models. Of the 351 HCC patients, 33 were diagnosed as having sarcopenia and showed poor prognosis compared with non-sarcopenia patients (p = 0.007). However, this significant difference disappeared after the adjustments for age, sex, Child–Pugh score, maximum tumor size, tumor number, and the degree of portal vein invasion by propensity score matching analysis. Multiple linear regression analysis showed that age (p = 0.015) and sex (p < 0.0001) were significantly correlated with a decrease in L3 SMI. Tree-based models revealed that sex (female) is the most significant factor that affects L3 SMI. In male patients, L3 SMI was decreased by aging, increased Child–Pugh score (≥56 years), and enlarged tumor size (<56 years). Maintaining liver functional reserve and early diagnosis and therapy for HCC are vital to prevent skeletal muscle depletion and improve the prognosis of patients with HCC. Full article

(This article belongs to the Special Issue Nutrition and Liver Disease)

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12 pages, 2908 KiB

Open AccessArticle

Protective Effects of Ethanolic Extracts from Artichoke, an Edible Herbal Medicine, against Acute Alcohol-Induced Liver Injury in Mice

by Xuchong Tang, Ruofan Wei, Aihua Deng and Tingping Lei

Nutrients 2017, 9(9), 1000; https://doi.org/10.3390/nu9091000 - 11 Sep 2017

Cited by 74 | Viewed by 13461

Abstract

Oxidative stress and inflammation are well-documented pathological factors in alcoholic liver disease (ALD). Artichoke (Cynara scolymus L.) is a healthy food and folk medicine with anti-oxidative and anti-inflammatory properties. This study aimed to evaluate the preventive effects of ethanolic extract from artichoke against acute alcohol-induced liver injury in mice. Male Institute of Cancer Research mice were treated with an ethanolic extract of artichoke (0.4, 0.8, and 1.6 g/kg body weight) by gavage once daily. Up to 40% alcohol (12 mL/kg body weight) was administered orally 1 h after artichoke treatment. All mice were fed for 10 consecutive days. Results showed that artichoke extract significantly prevented elevated levels of aspartate aminotransferase, alanine aminotransferase, triglyceride, total cholesterol, and malondialdehyde. Meanwhile, the decreased levels of superoxide dismutase and glutathione were elevated by artichoke administration. Histopathological examination showed that artichoke attenuated degeneration, inflammatory infiltration and necrosis of hepatocytes. Immunohistochemical analysis revealed that expression levels of toll-like receptor (TLR) 4 and nuclear factor-kappa B (NF-κB) in liver tissues were significantly suppressed by artichoke treatment. Results obtained demonstrated that artichoke extract exhibited significant preventive protective effect against acute alcohol-induced liver injury. This finding is mainly attributed to its ability to attenuate oxidative stress and suppress the TLR4/NF-κB inflammatory pathway. To the best of our knowledge, the underlying mechanisms of artichoke on acute ALD have been rarely reported. Full article

(This article belongs to the Special Issue Nutrition and Liver Disease)

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11 pages, 1124 KiB

Open AccessArticle

Impact of Virtual Touch Quantification in Acoustic Radiation Force Impulse for Skeletal Muscle Mass Loss in Chronic Liver Diseases

by Hiroki Nishikawa, Takashi Nishimura, Hirayuki Enomoto, Yoshinori Iwata, Akio Ishii, Yuho Miyamoto, Noriko Ishii, Yukihisa Yuri, Ryo Takata, Kunihiro Hasegawa, Chikage Nakano, Kazunori Yoh, Nobuhiro Aizawa, Yoshiyuki Sakai, Naoto Ikeda, Tomoyuki Takashima, Shuhei Nishiguchi and Hiroko Iijima

Nutrients 2017, 9(6), 620; https://doi.org/10.3390/nu9060620 - 16 Jun 2017

Cited by 3 | Viewed by 4551

Abstract

Background and aims: We sought to clarify the relationship between virtual touch quantification (VTQ) in acoustic radiation force impulse and skeletal muscle mass as assessed by bio-electronic impedance analysis in patients with chronic liver diseases (CLDs, n = 468, 222 males and 246 females, median age = 62 years). Patients and methods: Decreased skeletal muscle index (D-SMI) was defined as skeletal muscle index (SMI) <7.0 kg/m² for males and as SMI <5.7 kg/m² for females, according to the recommendations in current Japanese guidelines. We examined the correlation between SMI and VTQ levels and investigated factors linked to D-SMI in the univariate and multivariate analyses. The area under the receiver operating curve (AUROC) for the presence of D-SMI was also calculated. Results: In patients with D-SMI, the median VTQ level was 1.64 meters/second (m/s) (range, 0.93–4.32 m/s), while in patients without D-SMI, the median VTQ level was 1.11 m/s (range, 0.67–4.09 m/s) (p < 0.0001). In the multivariate analysis, higher VTQ was found to be an independent predictor linked to the presence of D-SMI (p < 0.0001). In receiver operating characteristic analysis, body mass index had the highest AUROC (0.805), followed by age (0.721) and VTQ (0.706). Conclusion: VTQ levels can be useful for predicting D-SMI in patients with CLDs. Full article

(This article belongs to the Special Issue Nutrition and Liver Disease)

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13 pages, 1426 KiB

Open AccessArticle

Comparison of Prognostic Impact between the Child-Pugh Score and Skeletal Muscle Mass for Patients with Liver Cirrhosis

by Hiroki Nishikawa, Hirayuki Enomoto, Akio Ishii, Yoshinori Iwata, Yuho Miyamoto, Noriko Ishii, Yukihisa Yuri, Kunihiro Hasegawa, Chikage Nakano, Takashi Nishimura, Kazunori Yoh, Nobuhiro Aizawa, Yoshiyuki Sakai, Naoto Ikeda, Tomoyuki Takashima, Ryo Takata, Hiroko Iijima and Shuhei Nishiguchi

Nutrients 2017, 9(6), 595; https://doi.org/10.3390/nu9060595 - 12 Jun 2017

Cited by 16 | Viewed by 5139

Abstract

Aims: To investigate the influence of skeletal muscle mass index (SMI) as determined by bioimpedance analysis (BIA) (appendicular skeletal muscle mass/(height)²) on survival by comparing the Child-Pugh score in patients with liver cirrhosis (LC, n = 383, average age = 65.2 years). Patients and methods: In terms of comparison of the effects of SMI and other markers on survival, we used time-dependent receiver operating characteristics (ROC) analysis. Results: The average SMI for male was 7.4 cm²/m² whereas that for female was 6.0 cm²/m² (p < 0.0001). As for the Child-Pugh score, five points were in the majority, both in males (51.7%, (106/205)) and females (44.9%, (80/178)). For both genders, the survival curve was well stratified according to SMI (p < 0.0001 for males and p = 0.0056 for females). In the multivariate analysis for survival, SMI and Child-Pugh scores were found to be significant both in males and females. In time-dependent ROC analyses, all area under the ROCs (AUROCs) for SMI in each time point were higher than those for Child-Pugh scores in males, while in females AUROCs for Child-Pugh scores at each time point were higher than those for SMI. Conclusion: SMI using BIA can be helpful for predicting outcomes, at least in male LC patients. Full article

(This article belongs to the Special Issue Nutrition and Liver Disease)

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Review

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10 pages, 225 KiB

Open AccessReview

Nutritional Therapies in Congenital Disorders of Glycosylation (CDG)

by Peter Witters, David Cassiman and Eva Morava

Nutrients 2017, 9(11), 1222; https://doi.org/10.3390/nu9111222 - 7 Nov 2017

Cited by 45 | Viewed by 8137

Abstract

Congenital disorders of glycosylation (CDG) are a group of more than 130 inborn errors of metabolism affecting N-linked, O-linked protein and lipid-linked glycosylation. The phenotype in CDG patients includes frequent liver involvement, especially the disorders belonging to the N-linked protein glycosylation group. There are only a few treatable CDG. Mannose-Phosphate Isomerase (MPI)-CDG was the first treatable CDG by high dose mannose supplements. Recently, with the successful use of d-galactose in Phosphoglucomutase 1 (PGM1)-CDG, other CDG types have been trialed on galactose and with an increasing number of potential nutritional therapies. Current mini review focuses on therapies in glycosylation disorders affecting liver function and dietary intervention in general in N-linked glycosylation disorders. We also emphasize now the importance of early screening for CDG in patients with mild hepatopathy but also in cholestasis. Full article

(This article belongs to the Special Issue Nutrition and Liver Disease)

16 pages, 1106 KiB

Open AccessReview

Nutritional Needs and Support for Children with Chronic Liver Disease

by Christine H. Yang, Brandon J. Perumpail, Eric R. Yoo, Aijaz Ahmed and John A. Kerner Jr.

Nutrients 2017, 9(10), 1127; https://doi.org/10.3390/nu9101127 - 16 Oct 2017

Cited by 61 | Viewed by 13012

Abstract

Malnutrition has become a dangerously common problem in children with chronic liver disease, negatively impacting neurocognitive development and growth. Furthermore, many children with chronic liver disease will eventually require liver transplantation. Thus, this association between malnourishment and chronic liver disease in children becomes increasingly alarming as malnutrition is a predictor of poorer outcomes in liver transplantation and is often associated with increased morbidity and mortality. Malnutrition requires aggressive and appropriate management to correct nutritional deficiencies. A comprehensive review of the literature has found that infants with chronic liver disease (CLD) are particularly susceptible to malnutrition given their low reserves. Children with CLD would benefit from early intervention by a multi-disciplinary team, to try to achieve nutritional rehabilitation as well as to optimize outcomes for liver transplant. This review explains the multifactorial nature of malnutrition in children with chronic liver disease, defines the nutritional needs of these children, and discusses ways to optimize their nutritional. Full article

(This article belongs to the Special Issue Nutrition and Liver Disease)

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25 pages, 1643 KiB

Open AccessReview

Nutritional Therapy in Liver Transplantation

by Ahmed Hammad, Toshimi Kaido, Vusal Aliyev, Claudia Mandato and Shinji Uemoto

Nutrients 2017, 9(10), 1126; https://doi.org/10.3390/nu9101126 - 16 Oct 2017

Cited by 63 | Viewed by 18812 | Correction

Abstract

Protein-energy malnourishment is commonly encountered in patients with end-stage liver disease who undergo liver transplantation. Malnutrition may further increase morbidity, mortality and costs in the post-transplantation setting. The importance of carefully assessing the nutritional status during the work-up of patients who are candidates for liver replacement is widely recognized. The metabolic abnormalities induced by liver failure render the conventional assessment of nutritional status to be challenging. Preoperative loss of skeletal muscle mass, namely, sarcopenia, has a significant detrimental impact on post-transplant outcomes. It is essential to provide sufficient nutritional support during all phases of liver transplantation. Oral nutrition is preferred, but tube enteral nutrition may be required to provide the needed energy intake. Herein, the latest currently employed perioperative nutritional interventions in liver transplant recipients are thoroughly illustrated including synbiotics, micronutrients, branched-chain amino acid supplementation, immunonutrition formulas, fluid and electrolyte balance, the offering of nocturnal meals, dietary counselling, exercise and rehabilitation. Full article

(This article belongs to the Special Issue Nutrition and Liver Disease)

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11 pages, 1223 KiB

Open AccessReview

Optimizing the Nutritional Support of Adult Patients in the Setting of Cirrhosis

by Brandon J. Perumpail, Andrew A. Li, George Cholankeril, Radhika Kumari and Aijaz Ahmed

Nutrients 2017, 9(10), 1114; https://doi.org/10.3390/nu9101114 - 13 Oct 2017

Cited by 15 | Viewed by 8863

Abstract

Aim: The aim of this work is to develop a pragmatic approach in the assessment and management strategies of patients with cirrhosis in order to optimize the outcomes in this patient population. Method: A systematic review of literature was conducted through 8 July 2017 on the PubMed Database looking for key terms, such as malnutrition, nutrition, assessment, treatment, and cirrhosis. Articles and studies looking at associations between nutrition and cirrhosis were reviewed. Results: An assessment of malnutrition should be conducted in two stages: the first, to identify patients at risk for malnutrition based on the severity of liver disease, and the second, to perform a complete multidisciplinary nutritional evaluation of these patients. Optimal management of malnutrition should focus on meeting recommended daily goals for caloric intake and inclusion of various nutrients in the diet. The nutritional goals should be pursued by encouraging and increasing oral intake or using other measures, such as oral supplementation, enteral nutrition, or parenteral nutrition. Conclusions: Although these strategies to improve nutritional support have been well established, current literature on the topic is limited in scope. Further research should be implemented to test if this enhanced approach is effective. Full article

(This article belongs to the Special Issue Nutrition and Liver Disease)

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19 pages, 419 KiB

Open AccessReview

Parenteral Nutrition-Associated Liver Disease: The Role of the Gut Microbiota

by Monika Cahova, Miriam Bratova and Petr Wohl

Nutrients 2017, 9(9), 987; https://doi.org/10.3390/nu9090987 - 7 Sep 2017

Cited by 64 | Viewed by 13861

Abstract

Parenteral nutrition (PN) provides life-saving nutritional support in situations where caloric supply via the enteral route cannot cover the necessary needs of the organism. However, it does have serious adverse effects, including parenteral nutrition-associated liver disease (PNALD). The development of liver injury associated with PN is multifactorial, including non-specific intestine inflammation, compromised intestinal permeability, and barrier function associated with increased bacterial translocation, primary and secondary cholangitis, cholelithiasis, short bowel syndrome, disturbance of hepatobiliary circulation, lack of enteral nutrition, shortage of some nutrients (proteins, essential fatty acids, choline, glycine, taurine, carnitine, etc.), and toxicity of components within the nutrition mixture itself (glucose, phytosterols, manganese, aluminium, etc.). Recently, an increasing number of studies have provided evidence that some of these factors are directly or indirectly associated with microbial dysbiosis in the intestine. In this review, we focus on PN-induced changes in the taxonomic and functional composition of the microbiome. We also discuss immune cell and microbial crosstalk during parenteral nutrition, and the implications for the onset and progression of PNALD. Finally, we provide an overview of recent advances in the therapeutic utilisation of pro- and prebiotics for the mitigation of PN-associated liver complications. Full article

(This article belongs to the Special Issue Nutrition and Liver Disease)

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