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Hepatologists have some primary tasks to accomplish with their patients: (1) to eradicate or halt viral infections; (2) to stop alcohol abuse; (3) to prevent and, later, treat common life-threatening complications (ascites, variceal bleeding, encephalopathy); (4) to support liver function and keep patients under surveillance for the risk of liver cancer; and (5) to decide on the timing for possible liver transplantation. All these tasks point to reduced liver-related mortality as the ultimate target.
The nutritional status has long attracted attention as a factor generally associated with outcome; the majority of studies indicate a poor nutritional status (protein–calorie malnutrition) as potentially associated with mortality risk.1 This was mainly the case of skid-row patients with alcoholic liver disease (ALD), whereas a large observational Italian study in subjects with cirrhosis indicated that 29% of females and 18% of males were over-nourished.2 The precise aetiology of liver disease was not clearly defined at that time, but in the same years it became clear that obesity and other metabolic alterations were per se potential causes of liver disease, following the seminal observation linking fatty liver to ‘cryptogenic cirrhosis’, via non-alcoholic steatohepatitis. We now know that non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome,3 a …