Liver disease in obesity and underweight: the two sides of the coin. A narrative review
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REVIEW
Liver disease in obesity and underweight: the two sides of the coin. A narrative review Renata Risi1 · Dario Tuccinardi2 · Stefania Mariani1 · Carla Lubrano1 · Silvia Manfrini2 · Lorenzo Maria Donini1 · Mikiko Watanabe1 Received: 12 September 2020 / Accepted: 16 October 2020 © Springer Nature Switzerland AG 2020
Abstract Purpose Malnutrition, whether characterized by not enough or too much nutrient intake, is detrimental to the liver. We herein provide a narrative literature revision relative to hepatic disease occurrence in over or undernourished subjects, to shed light on the paradox where both sides of malnutrition lead to similar liver dysfunction and fat accumulation. Methods Medline, EMBASE, and Cochrane Library were searched for publications up to July 2020. Articles discussing the association between both chronic and acute liver pathology and malnutrition were evaluated together with studies reporting the dietary intake in subjects affected by malnutrition. Results The association between overnutrition and non-alcoholic fatty liver disease (NAFLD) is well recognized, as the beneficial effects of calorie restriction and very low carbohydrate diets. Conversely, the link between undernutrition and liver injury is more complex and less understood. In developing countries, early exposure to nutrient deficiency leads to marasmus and kwashiorkor, accompanied by fatty liver, whereas in developed countries anorexia nervosa is a more common form of undernutrition, associated with liver injury. Weight gain in undernutrition is associated with liver function improvement, whereas no study on the impact of macronutrient distribution is available. We hypothesized a role for very low carbohydrate diets in the management of undernutrition derived liver pathology, in addition to the established one in overnutrition-related NAFLD. Conclusions Further studies are warranted to update the knowledge regarding undernutrition-related liver disease, and a specific interest should be paid to macronutrient distribution both in the context of refeeding and relative to its role in the development of hepatic complications of anorexia nervosa. Level of evidence Narrative review, Level V. Keywords Eating disorder · Anorexia nervosa · Liver failure · Diet · Very low carbohydrate diet · Treatment · NAFLD · Malnutrition
Introduction Malnutrition, whether characterized by not enough or too much nutrient intake, is proven to be detrimental to the liver. While the pathophysiology underlying the development of * Dario Tuccinardi [email protected] 1
Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, 00161 Rome, Italy
Department of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico of Rome, Via Alvaro del Portillo, 21, 00128 Rome, Italy
2
non-alcoholic fatty liver disease (NAFLD) following chronic overnutrition is well recognized [1], the negative impact of undernutrition on the liver is complex and le
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