- Appetite loss and reduced caloric intake (anorexia) are common in cirrhosis
- Consider contributing causes and treat if appropriate according to goals of care.
- There is no robust cirrhosis specific data evaluating pharmacological therapy
- Refer to additional topics under the Healthy Living tab (malnutrition, frailty)
Anorexia is multifactorial, in part related to changes in pro-inflammatory upregulation and appetite mediators as liver disease progresses.
A dietician consult and guidance can help evaluate and improve a patient’s nutrition.
Interdisciplinary consultation as appropriate – Dietitian, speech language pathologist, occupational therapist, physical therapist
Initiation of enteral supplementation can be discussed in concert with a Dietitian or Nutrition Specialist.
This section was adapted from content using the following evidence based resources in combination with expert consensus. The presented information is not intended to replace the independent medical or professional judgment of physicians or other health care providers in the context of individual clinical circumstances to determine a patient’s care.
Authors (Alphabetical): Amanda Brisebois, Sarah Burton-Macleod, Ingrid DeKock , Martin Labrie, Noush Mirhosseini, Mino Mitri, Kinjal Patel, Aynharan Sinnarajah, Puneeta Tandon
Thank you to pharmacists Omer Ghutmy and Meghan Mior for their help with reviewing these pages.
- Goals of care: https://www.albertahealthservices.ca/frm-103547.pdf
- Frailty and Malnutrition: http://cirrhosiscare.ca/healthy-living-provider/frailty-and-malnutrition-screening-hcp/
- Physical Activity: http://cirrhosiscare.ca/healthy-living-provider/exercise-therapy-hcp/
- Nutrition Therapy: http://cirrhosiscare.ca/healthy-living-provider/nutrition-therapy-hcp/
- Constipation: http://cirrhosiscare.ca/healthy-living-provider/constipation-hcp/
- Depression: http://cirrhosiscare.ca/healthy-living-provider/depression-hcp/
- Davison SN on behalf of the Kidney Supportive Care Research Group. Conservative Kidney Management Pathway; Available from: https//:www.CKMcare.com.
- Bruera E. ABC of palliative care. Anorexia, cachexia, and nutrition. BMJ. 1997 Nov 8;315(7117):1219-22. doi: 10.1136/bmj.315.7117.1219. PMID: 9393230; PMCID: PMC2127742.
- Bunchorntavakul C, Reddy KR. Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis. Aliment Pharmacol Ther. 2020 Jan;51(1):64-77. doi: 10.1111/apt.15571. Epub 2019 Nov 8. PMID: 31701570.
- Ruiz-García V, López-Briz E, Carbonell-Sanchis R, Bort-Martí S, Gonzálvez-Perales JL. Megestrol acetate for cachexia-anorexia syndrome. A systematic review. J Cachexia Sarcopenia Muscle. 2018 Jun;9(3):444-452. doi: 10.1002/jcsm.12292. Epub 2018 Mar 14. PMID: 29542279; PMCID: PMC5989756