Disordered energy and protein metabolism in liver disease.

Although progress has been made, more information is needed on the role of nutritional therapy in liver disease. Because considerable heterogeneity exists among patients regarding both nutritional needs and the pathophysiology of malnutrition, their nutritional status must be monitored to permit careful selection and individualization of therapy. It is important to remember that the factors controlling nutritional status and overall survival in cirrhosis are multifactorial and the pathophysiologic mechanisms influencing outcome remained to be further defined. Consequently, it seems unlikely that any single therapy will be effective alone. In this regard, it should be emphasized that nutritional management should not be aimed solely at restoring normal metabolic homeostasis but should maximize anabolic regenerative processes in addition and minimize abnormal liver function so as to promote the effectiveness of other interventional therapies in patients with chronic liver disease.