Nutrition in Chronic Liver Disease

Chronic liver disease (CLD), also known as cirrhosis, is a serious condition that is linked to drastic weight loss and the degradation of lean muscle due to decreased protein production and increased breakdown of muscle protein [1]. Reduced liver function also negatively alters nutrient absorption and this typically leads to malnutrition that is associated with life-threatening complications and an increased risk of death [2]. Indeed, the prevalence of malnutrition in individuals with CLD is about 60-90% for this particular population [3].

One of the main causes of CLD-induced malnutrition is an imbalance of nitrogen [4]. As nitrogen levels decrease, the body tries to meet its demands for this substance by breaking down more muscle protein and this typically causes protein to be degraded faster than it can be replaced through a regular diet. The body also needs more energy in the form of increased calories to compensate for the body’s attempt to heal the liver damage, but if caloric intake is not significantly increased, the body will also use muscle protein as a source of energy [1]. This process leads to protein-energy malnutrition as well as hepatic cachexia, which is characterized as the progressive loss of muscle due to excessive muscle protein degradation, improper responses to insulin release, and heightened blood sugar levels; all of which contribute to the wasting of muscle [5]. The net effect of this increased protein and calorie (energy) requirement is macronutrient deficiencies that must be addressed through supplementation.

Role of Oral Nutritional Supplements

According to the American Association for the Study of Liver Diseases (AASLD), oral branched-chain amino acids (BCAAs) are a useful alternative or a beneficial addition to the conventional treatment for people with CLD or liver-damage induced brain dysfunction (hepatic encephalopathy), especially for those who have not responded to previous treatments [6]. One of the reasons that BCAA supplementation is beneficial is due to its ability to promote heightened levels of nitrogen, a substance that promotes protein synthesis for muscle growth. BCAAs also target blood sugar-related muscle loss by improving blood sugar regulation [7]. By supporting healthy blood sugar levels, BCAAs help prevent further skeletal muscle loss.

One clinical study involving BCAAs evaluated the introduction of a controlled diet of 45 to 65 grams (g) of protein for 15 days to individuals with CLD, followed by the administration of 0.24 g per kilogram of BCAAs on day 16 in combination with their diet. After three months, the status of the liver significantly improved. This was attributed to enhanced nitrogen balance that remained heightened in response to BCAA supplementation [8]. These types of clinical findings have been repeatedly demonstrated with regard to BCAA supplement for improved liver health [9-12]. 

BCAA supplementation also targets hepatic encephalopathy, which refers to brain dysfunction that is the result of liver damage [13, 14]. In addition, BCAA supplementation for prolonged periods of time (e.g., 2 years) has been shown to improve event-free survival for people with CLD [15]. Therefore, nutrient supplementation is vital toward the management of CLD.


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