Nutrition IN Liver AND GI Disease

The answer first

Nutritional assessment and support in patients with liver and gastrointestinal disease is a core physician skill that materially changes outcomes. The FRACP candidate must defend the MUST screening tool for hospitalised patients, the diagnostic criteria for refeeding syndrome (hypophosphataemia less than 0.5 mmol/L within 72 hours of refeeding, with or without hypokalaemia, hypomagnesaemia, fluid overload, arrhythmia), the calorie escalation protocol (start 5-10 kcal/kg/day in high-risk patients, increase over 4-7 days), and the sarcopenia assessment in cirrhosis (skeletal muscle index on CT). The answer-first synthesis is: screen every hospitalised patient for malnutrition, identify high-risk patients for refeeding syndrome before nutritional support, correct electrolyte and micronutrient deficiencies before refeeding, start at low calorie and titrate, and address disease-specific requirements (sodium restriction in cirrhosis with ascites; high calorie and high protein in IBD; fat restriction in chylous ascites). [2] [3]

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1. [1]Dent E, Hoogendijk EO, Visvanathan R et al. Malnutrition Screening and Assessment in Hospitalised Older People: a Review The journal of nutrition, health & aging, 2019.PMID 31021360
2. [2]Wunderle C, Gomes F, Schuetz P et al. ESPEN guideline on nutritional support for polymorbid medical inpatients Clinical nutrition (Edinburgh, Scotland), 2023.PMID 37478809
3. [3]Reber E, Friedli N, Vasiloglou MF et al. Management of Refeeding Syndrome in Medical Inpatients Journal of clinical medicine, 2019.PMID 31847205
4. [4]Matthews-Rensch K, Blackwood K, Lawlis D et al. The Australasian Society of Parenteral and Enteral Nutrition: Consensus statements on refeeding syndrome Nutrition & dietetics : the journal of the Dietitians Association of Australia, 2025.PMID 40090863
5. [5]Bischoff SC, Bernal W, Dasarathy S et al. ESPEN practical guideline: Clinical nutrition in liver disease Clinical nutrition (Edinburgh, Scotland), 2020.PMID 33213977
6. [6]Bischoff SC, Escher J, Hébuterne X et al. ESPEN practical guideline: Clinical Nutrition in inflammatory bowel disease Clinical nutrition (Edinburgh, Scotland), 2020.PMID 32029281
7. [7]Allen SL, Quinlan JI, Dhaliwal A et al. Sarcopenia in chronic liver disease: mechanisms and countermeasures American journal of physiology. Gastrointestinal and liver physiology, 2021.PMID 33236953
8. [8]Tadokoro T, Morishita A, Himoto T et al. Nutritional Support for Alcoholic Liver Disease Nutrients, 2023.PMID 36986091
9. [9]Weisshof R, Chermesh I Micronutrient deficiencies in inflammatory bowel disease Current opinion in clinical nutrition and metabolic care, 2015.PMID 26418823
10. [10]Barker LA, Gout BS, Crowe TC Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system International journal of environmental research and public health, 2011.PMID 21556200