Malnutrition in hepatitis C virus (HCV) disease

Abstract

Hepatitis C is a viral infection of the hepatocytes that commonly presents as a chronic progressive liver disease. In its chronic form, HCV is often associated with nutritional disturbances secondary to the impaired metabolic function of the liver. In fact, the prevalence of malnutrition is believed to be as high as 65-90% in patients with chronic liver disease. Malnutrition in Chronic HCV may present as protein-calorie malnutrition, manifesting as Sarcopenia or as micronutrient deficiencies. In addition to the signs and symptoms of the underlying liver disease, malnourished patients often present with weight loss, anorexia, nausea, skin and vision changes, as well neurological deficits. In chronic liver disease, nutritional impairment stems from a combination of disturbances in oral intake, absorption of macro- and micronutrients, and regulation of the physiological and biochemical processes of the body. Subjective Global assessment is often favored as a screening tool for easy identification of malnutrition in HCV patients as it can be used in all settings. More Specialized tools like bioelectric impedance analysis and Dual-energy Xray absorptiometry are not widely available and only indicated in certain patients such as liver transplant candidates. Additional laboratory investigations such as Serum levels of proteins like albumin may also provide useful clues regarding the nutritional status of HCV patients, but only in the absence of decompensated liver disease. Management of malnutrition in chronic HCV patients resolves primarily around restoring muscle health. A significant aspect of management is to ensure a balanced diet that contains an adequate amount of calories and limits the amount of fat and simple sugars like fructose that have been implicated in the progression of liver disease.