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J Pediatr Gastroenterol Nutr. 2019 Oct;69(4):498-511. doi: 10.1097/MPG.0000000000002443.

Nutrition Support of Children With Chronic Liver Diseases: A Joint Position Paper of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

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Cincinnati Children's Hospital Medical Center, University of Cincinnati School of Medicine, Cincinnati OH.
Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.
Liver Unit, Birmingham Children's Hospital, Birmingham, United Kingdom.
Children's Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.
Department of Pediatrics, McMaster University, Hamilton, Canada.
Children's Hospital and Medical Center, University of Nebraska Medical Center, Omaha NE.
Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora, CO.


Chronic liver disease places patients at increased risk of malnutrition that can be challenging to identify clinically and treat. Nutrition support is a key aspect of the management of these patients as it has an impact on their quality of life, morbidity, and mortality. There are significant gaps in the literature regarding the optimal nutrition support for patients with different types of liver diseases and the impact of these interventions on long-term outcomes. This Position Paper summarizes the available literature on the nutritional aspects of the care of patients with chronic liver diseases. Specifically, the challenges associated with the nutritional assessment of these subjects are discussed, and recently investigated approaches to determining the patients' nutritional status are reviewed. Furthermore, the pathophysiology of the malnutrition seen in the context of chronic liver disease is summarized and monitoring, as well as treatment, recommendations are provided. Lastly, suggestions for future research studies are described.

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