PREVALENCE
Protein–calorie malnutrition (PCM)—a condition of body wasting related to dietary deficiency of calories and protein—is found in 65–90% of patients with advanced liver disease and in almost 100% of candidates for liver transplantation.8, 9 Patients with chronic liver disease also frequently develop micronutrient deficiencies, which can have a more insidious presentation than the overt cachexia seen in patients with PCM. There is a direct correlation between the progression of the liver disease and the severity of malnutrition.10, 11 Malnutrition develops in patients with cirrhosis irrespective of the etiology of their disease12 and occurs with roughly equal incidence in patients with alcoholic and nonalcoholic liver disease.13 Patients with cholestatic liver disease are subject to calorie depletion, whereas patients with noncholestatic disease predominantly experience protein depletion.14 Additionally, cholestatic disease is more frequently associated with a deficiency in fat-soluble vitamins than noncholestatic disease.15 Malnutrition is not typically a complication of acute liver injury, but manifests with progression to liver failure.