Prevention and management of malnutrition are essential to improve clinical outcomes for patients with cirrhosis. Depending on the population and assessment method of malnutrition, it is estimated that 50% to 90% of individuals with cirrhosis have malnutrition. 1 Individuals may struggle to meet calorie and protein requirements for a multitude of reasons, including but not limited to: increased nutrient requirements, reduced intake, malabsorption, and alterations in protein and glucose metabolism. Early nutrition education and aggressive nutrition interventions are imperative for preventing and halting progression of malnutrition in the population of patients with cirrhosis.
To prevent and treat malnutrition in patients with cirrhosis, clinicians need to prioritize nutrition care for the individual. Given the complexity of nutrition management, a registered dietitian should be involved in the care of these patients to complete a detailed nutrition assessment and intervention. Health literacy, socioeconomic status, social support, and alterations in mental status should all be considered when performing nutrition assessments and providing diet education. Clinicians need to be flexible and concise in their recommendations so that patients understand exactly which nutrition goals to prioritize. In addition, nutrition priorities and goals may change as acuity of the patient's clinical status changes (i.e., decompensated in the hospital versus well‐compensated at home). When discussing nutrition recommendations, total caloric intake and allocation of other macronutrients are important factors given the metabolic changes seen in those with cirrhosis.
The first nutrition priority for the patient with cirrhosis is to promote overall adequate intake regardless of the macronutrient distribution (Fig. (Fig.1). 1 ). Ensuring overall adequate intake decreases the duration of the fasting state in the body and in turn prevents muscle catabolism. Caloric recommendations for patients with cirrhosis are listed in Table Table1 1 .
Progression of nutrition provision priorities for the patient with cirrhosis.
