Optimizing Nutritional Management in Children with Chronic Liver Disease

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Pathophysiology of malnutrition in childhood liver disease

The development of malnutrition in children with CLD is complex and involves multiple mechanisms, including decreased dietary intake, malabsorption, increased energy expenditure, and disordered substrate use (Box 2).

Approach to the assessment of nutritional status in children with liver disease

Routine nutritional assessment of an infant or child with CLD is a cornerstone of management and should be undertaken at every visit. An approach encompassing a comprehensive history and physical examination, including anthropometry when possible, followed by laboratory testing and specialized investigations as necessary is enhanced by the involvement of a multidisciplinary team (Table 1).

General Management Issues

Nutritional management must be tailored to the nature and degree of malnutrition of the infant or child with CLD. The goal of early intervention is to prevent or correct deficiencies, improve growth, and, ultimately, reduce morbidity and mortality. Nutritional intervention must attempt to compensate for anorexia, increased energy requirements, malabsorption, and abnormal substrate use.

Current caloric intake needs to be regularly reviewed and compared with the child's needs. Based on weight,

Summary

Malnutrition is common in children with CLD and may easily be underestimated by clinical appearance alone. Infants with CLD are more at risk than older children for severe malnutrition and have lower reserves. The cause of malnutrition in CLD is multifactorial, although insufficient dietary intake is probably the most important cause and is correctable. Fat malabsorption occurs in cholestatic disorders, and one must also consider any accompanying fat-soluble vitamin and essential fatty acid

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    This work was supported by a grant from the Eric Burnard Trust, Royal Australasian College of Physicians.

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