• Prevent further liver injury and promote liver regeneration
• Slow the progression of liver dysfunction
• Minimize the risk of infections
• Prevent macro- and micronutrient deficiencies
• Maximize growth potential and overall health outcomes

Effective nutritional management is therefore essential to improving the quality of life and prognosis for individuals with chronic liver disease.

Significance Of Micronutrients

Vitamins

Deficiencies in water-soluble vitamins (particularly vitamins B and C) are common in patients with alcoholic cirrhosis, and they may also occur in non-alcoholic liver diseases. Notably, thiamine (vitamin B1) deficiency increases the risk of Wernicke’s encephalopathy and Korsakoff’s dementia, especially in patients with alcoholic liver disease and hepatitis C.

Fat-soluble vitamin deficiencies are more frequently observed in cholestatic liver disorders. For example:

• Vitamin A (retinol) deficiency is well-documented in cirrhosis and is considered a risk factor for the development of cancers, including hepatocellular carcinoma.
• Vitamin E, a potent antioxidant, is reduced in conditions such as cholestasis and alcoholic liver disease, potentially contributing to increased oxidative stress.

Minerals

Advanced chronic liver disease often leads to water-electrolyte imbalances, clinically manifested as ascites and peripheral edema.

• Sodium retention plays a central role in the development of ascites and edema in chronic liver disease. Therefore, dietary sodium restriction combined with careful fluid monitoring is essential to maintain fluid balance and prevent complications.
• Potassium supplementation is frequently necessary to correct hypokalemia caused by losses through diarrhea, diuretic use, or hyperaldosteronism.
• Deficiencies of trace elements such as selenium and zinc are common in patients with chronic alcoholism, due to reduced intake, impaired absorption, and increased urinary excretion induced by diuretics.
• Supplementing zinc has been shown to improve glucose metabolism in cirrhotic patients, addressing impaired glucose tolerance and diabetes frequently observed in this population.
• Magnesium deficiency is also prevalent in alcoholic liver disease. Muscle magnesium levels are an independent predictor of muscle strength, likely related to decreased sodium-potassium pump activity in skeletal muscles associated with magnesium deficiency.

• Metabolic disease
• celiac disease
• failure to thrive
• childhood obesity