A: Nutrient Intake
Poor intake is prevalent (27%-87%) in patients with alcoholic and non-alcoholic liver disease.
Poor intake is attributed to:
- Anorexia
- Nausea
- Early satiety (due to ascites)
- Unpalatable diets (salt/protein restricted diets)
B: Malabsorption
Moderate Steatorrhea (<12g/day) occurs in both cholestatic and non-cholestatic liver disease. Steatorrhea may exceed 30g/day in some patients. Malabsorption is mainly due to
- Decreased intestinal bile acids
- Pancreatic insufficiency
C: Major Protein Loss
- Cirrhosis patients have increased rate of protein breakdown. Due to alterations in energy metabolism, amino acids gets oxidized for energy. Other reasons of protein loss could be:
- Irreversible loss of nitrogen
- Increased rate of gluconeogenesis
- GI bleeding contributes to protein loss
- Large-volume paracentesis may also cause loss of proteins