Significance Of Micronutrients

Vitamins

• Deficiencies in water-soluble vitamins (B and C) are common in alcoholic cirrhosis in particular but also occur in nonalcoholic liver disease.
• The risks of Wernicke’s encephalopathy and Korsakoff’s dementia are well described in alcoholic and hepatitis C-related patients deficient in thiamine.
• Fat-soluble vitamin deficiencies occur more commonly in the cholestatic liver syndromes.
• Vitamin A (retinol) deficiency has been described in cirrhosis and is considered a risk factor for development of cancer, including hepatocellular carcinoma.
• Vitamin E, an antioxidant, is reduced in cholestasis and alcoholic liver disease.

Minerals

• The presence of advanced chronic liver disease leads to water-electrolyte imbalances clinically characterized by ascites and peripheral edema.
• Sodium retention plays a key role in the pathophysiology of ascites and edema formation in chronic liver disease. Dietary sodium restriction, with accurate fluid monitoring, is needed to maintain homeostasis.
• Potassium supplementation is often required to correct the hypokalemia due to losses from diarrhea, use of diuretics, or hyperaldosteronism.
• Low levels of trace elements such as selenium and zinc have been described in patients with chronic alcoholism is attributed to decreased intake and absorption and diuretic-induced increased urinary excretion.
• Supplementation with zinc has been shown to improve glucose disposal in cirrhotic patients, and deficiency may contribute to the impaired glucose tolerance and diabetes commonly observed.
• Magnesium deficiency occurs in alcoholic liver disease, and muscle magnesium is an independent predictor of muscle strength. This is probably related to the reduced content of sodium-potassium pumps in skeletal muscle that accompanies magnesium deficiency.

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