Malnutrition, frailty, sarcopenia, obesity—optimizing nutrition care in liver transplantation

Protein calorie malnutrition is widely present in individuals with end-stage liver disease undergoing liver transplant. Nutritional depletion of lean body mass (sarcopenia) and fat reserve may increase surgical risk, morbidity, mortality, and health care costs. Patients may present with sarcopenic obesity or obesity prior to transplant which carries into the post-transplant setting. Obesity is associated with many co-morbid conditions including metabolic syndrome affecting long-term mortality. Identifying malnourished patients and optimizing protein and energy intake throughout the transplant process is discussed. Strategies to preserve and improve lean body tissue and mitigate excessive weight gain are presented.