Skip to main content
SpringerLink
Log in

Promoting a Healthy Lifestyle, Managing Hyperlipidemia, Diabetes Mellitus, Hypertension, and Immunizations in Patients with Cirrhosis

  • Chapter
  • First Online:
Book cover Complications of Cirrhosis

  • 1936 Accesses

Abstract

Maximizing the general well-being of the patient with cirrhosis is an ongoing challenge, with limited information about the optimal approach. In this chapter, we discuss the management of some common comorbid conditions, including diabetes mellitus (DM), hypertension, and hyperlipidemia. We also review the approach to weight loss and exercise, as obesity and decreased physical fitness are significant concerns in this population and can have major negative consequences, including increased operative risk, higher rates of decompensation, and hepatocellular cancer. Finally, we summarize the current recommendations for vaccinations, an important component in the primary care of the patient with cirrhosis.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Vizzini AaA-MJ. Malnutrition in patients with cirrhosis. In: Keaveny AP, Cardenas A, editors. Complications of cirrhosis evaluation and management. New York: Springer; 2015.

    Google Scholar 

  2. Fan JG, Cao HX. Role of diet and nutritional management in non-alcoholic fatty liver disease. J Gastroenterol Hepatol. 2013;28(Suppl 4):81–7.

    Article  CAS  PubMed  Google Scholar 

  3. Shiraki M, Nishiguchi S, Saito M, Fukuzawa Y, Mizuta T, Kaibori M, et al. Nutritional status and quality of life in current patients with liver cirrhosis as assessed in 2007–2011. Hepatol Res: Off J Jpn Soc Hepatol. 2013;43(2):106–12.

    Article  Google Scholar 

  4. Evert AB, Boucher JL, Cypress M, Dunbar SA, Franz MJ, Mayer-Davis EJ, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care. 2014;37(Suppl 1):S120–43.

    Article  PubMed  Google Scholar 

  5. Basaranoglu M, Basaranoglu G, Sabuncu T, Senturk H. Fructose as a key player in the development of fatty liver disease. World J Gastroenterol. 2013;19(8):1166–72.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  6. Vos MB, Lavine JE. Dietary fructose in nonalcoholic fatty liver disease. Hepatology. 2013;57(6):2525–31.

    Article  CAS  PubMed  Google Scholar 

  7. Saab S, Mallam D, Cox GA, 2nd, Tong MJ. Impact of coffee on liver diseases: a systematic review. Liver Int: Off J Int Assoc Study Liver. 2014;34(4):495–504.

    Article  Google Scholar 

  8. Cadden IS, Partovi N, Yoshida EM. Review article: possible beneficial effects of coffee on liver disease and function. Aliment Pharmacol Ther. 2007;26(1):1–8.

    Article  CAS  PubMed  Google Scholar 

  9. Honjo S, Kono S, Coleman MP, Shinchi K, Sakurai Y, Todoroki I, et al. Coffee consumption and serum aminotransferases in middle-aged Japanese men. J Clin Epidemiol. 2001;54(8):823–9.

    Article  CAS  PubMed  Google Scholar 

  10. Carrieri MP, Lions C, Sogni P, Winnock M, Roux P, Mora M, et al. Association between elevated coffee consumption and daily chocolate intake with normal liver enzymes in HIV-HCV infected individuals: results from the ANRS CO13 HEPAVIH cohort study. J Hepatol. 2014;60(1):46–53.

    Article  CAS  PubMed  Google Scholar 

  11. Bravi F, Bosetti C, Tavani A, Gallus S, La Vecchia C. Coffee reduces risk for hepatocellular carcinoma: an updated meta-analysis. Clin Gastroenterol Hepatol: Off Clin Prac J Am Gastroenterol Assoc. 2013;11(11):1413–21, e1.

    Article  CAS  Google Scholar 

  12. Freedman ND, Everhart JE, Lindsay KL, Ghany MG, Curto TM, Shiffman ML, et al. Coffee intake is associated with lower rates of liver disease progression in chronic hepatitis C. Hepatology. 2009;50(5):1360–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Anty R, Marjoux S, Iannelli A, Patouraux S, Schneck AS, Bonnafous S, et al. Regular coffee but not espresso drinking is protective against fibrosis in a cohort mainly composed of morbidly obese European women with NAFLD undergoing bariatric surgery. J Hepatol. 2012;57(5):1090–6.

    Article  CAS  PubMed  Google Scholar 

  14. Costentin CE, Roudot-Thoraval F, Zafrani ES, Medkour F, Pawlotsky JM, Mallat A, et al. Association of caffeine intake and histological features of chronic hepatitis C. J Hepatol. 2011;54(6):1123–9.

    Article  CAS  PubMed  Google Scholar 

  15. Goh GB, Chow WC, Wang R, Yuan JM, Koh WP. Coffee, alcohol and other beverages in relation to cirrhosis mortality: the Singapore Chinese Health Study. Hepatology. 2014;60(2):661–9.

    Article  PubMed  Google Scholar 

  16. Jang ES, Jeong SH, Lee SH, Hwang SH, Ahn SY, Lee J, et al. The effect of coffee consumption on the development of hepatocellular carcinoma in hepatitis B virus endemic area. Liver Int: Off J Int Assoc Study Liver. 2013;33(7):1092–9.

    Article  CAS  Google Scholar 

  17. Klatsky AL, Morton C, Udaltsova N, Friedman GD. Coffee, cirrhosis, and transaminase enzymes. Archiv Inter Med. 2006;166(11):1190–5.

    Article  Google Scholar 

  18. Lai GY, Weinstein SJ, Albanes D, Taylor PR, McGlynn KA, Virtamo J, et al. The association of coffee intake with liver cancer incidence and chronic liver disease mortality in male smokers. Br J Cancer. 2013;109(5):1344–51.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Larsson SC, Wolk A. Coffee consumption and risk of liver cancer: a meta-analysis. Gastroenterology. 2007;132(5):1740–5.

    Article  PubMed  Google Scholar 

  20. Modi AA, Feld JJ, Park Y, Kleiner DE, Everhart JE, Liang TJ, et al. Increased caffeine consumption is associated with reduced hepatic fibrosis. Hepatology. 2010;51(1):201–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Ruhl CE, Everhart JE. Coffee and tea consumption are associated with a lower incidence of chronic liver disease in the United States. Gastroenterology. 2005;129(6):1928–36.

    Article  PubMed  Google Scholar 

  22. Tverdal A, Skurtveit S. Coffee intake and mortality from liver cirrhosis. Ann Epidemiol. 2003;13(6): 419–23.

    Article  PubMed  Google Scholar 

  23. Jones JC, Coombes JS, Macdonald GA. Exercise capacity and muscle strength in patients with cirrhosis. Liver Transplant: Off Publ Am Assoc Study Liver Dis Int Liver Transplant Soc. 2012;18(2):146–51.

    Article  Google Scholar 

  24. Lemyze M, Dharancy S, Neviere R, Wallaert B. Cardiopulmonary response to exercise in patients with liver cirrhosis and impaired pulmonary gas exchange. Respir Med. 2011;105(10):1550–6.

    Article  PubMed  Google Scholar 

  25. Dharancy S, Lemyze M, Boleslawski E, Neviere R, Declerck N, Canva V, et al. Impact of impaired aerobic capacity on liver transplant candidates. Transplantation. 2008;86(8):1077–83.

    Article  PubMed  Google Scholar 

  26. Rodriguez B, Torres DM, Harrison SA. Physical activity: an essential component of lifestyle modification in NAFLD. Nat Rev Gastroenterol Hepatol. 2012;9(12):726–31.

    Article  PubMed  Google Scholar 

  27. Johnson NA, Keating SE, George J. Exercise and the liver: implications for therapy in fatty liver disorders. Semin Liver Dis. 2012;32(1):65–79.

    Article  CAS  PubMed  Google Scholar 

  28. Nelson ME, Rejeski WJ, Blair SN, Duncan PW, Judge JO, King AC, et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116(9):1094–105.

    Article  PubMed  Google Scholar 

  29. Kistler KD, Brunt EM, Clark JM, Diehl AM, Sallis JF, Schwimmer JB, et al. Physical activity recommendations, exercise intensity, and histological severity of nonalcoholic fatty liver disease. Am J Gastroenterol. 2011;106(3):460–8. (quiz 9).

    Article  PubMed Central  PubMed  Google Scholar 

  30. Garcia-Pagan JC, Santos C, Barbera JA, Luca A, Roca J, Rodriguez-Roisin R, et al. Physical exercise increases portal pressure in patients with cirrhosis and portal hypertension. Gastroenterology. 1996;111(5):1300–6.

    Article  CAS  PubMed  Google Scholar 

  31. Bandi JC, Garcia-Pagan JC, Escorsell A, Francois E, Moitinho E, Rodes J, et al. Effects of propranolol on the hepatic hemodynamic response to physical exercise in patients with cirrhosis. Hepatology. 1998;28(3):677–82.

    Article  CAS  PubMed  Google Scholar 

  32. Loria P, Marchesini G, Nascimbeni F, Ballestri S, Maurantonio M, Carubbi F, et al. Cardiovascular risk, lipidemic phenotype and steatosis. A comparative analysis of cirrhotic and non-cirrhotic liver disease due to varying etiology. Atherosclerosis. 2014;232(1):99–109.

    Article  CAS  PubMed  Google Scholar 

  33. Kumar S, Grace ND, Qamar AA. Statin use in patients with cirrhosis: a retrospective cohort study. Dig Dis Sci. 2014;59:1958–65.

    Article  CAS  PubMed  Google Scholar 

  34. Stone NJ, Robinson JG, Lichtenstein AH, Bairey Merz CN, Blum CB, Eckel RH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63(25 Pt B):2889–934.

    Article  PubMed  Google Scholar 

  35. Chang CH, Chang YC, Lee YC, Liu YC, Chuang LM, Lin JW. Severe hepatic injury associated with different statins in patients with chronic liver disease: a nationwide population-based cohort study. J Gastroenterol Hepatol. 2014;30:155–62.

    Article  Google Scholar 

  36. de Denus S, Spinler SA, Miller K, Peterson AM. Statins and liver toxicity: a meta-analysis. Pharmacotherapy. 2004;24(5):584–91.

    Article  CAS  PubMed  Google Scholar 

  37. Florentin M, Liberopoulos EN, Elisaf MS. Ezetimibe-associated adverse effects: what the clinician needs to know. Int J Clin Prac. 2008;62(1):88–96.

    Article  CAS  Google Scholar 

  38. Hickman IJ, Macdonald GA. Impact of diabetes on the severity of liver disease. Am J Med. 2007;120(10):829–34.

    Article  PubMed  Google Scholar 

  39. Loria P, Lonardo A, Anania F. Liver and diabetes. A vicious circle. Hepatol Res: Off J Jpn Soc Hepatol. 2013;43(1):51–64.

    Article  CAS  Google Scholar 

  40. Goswami A, Bhargava N, Dadhich S, Kulamarva G. Insulin resistance in euglycemic cirrhosis. Ann Gastroenterol: Q Publ Hellenic Soc Gastroenterol. 2014;27(3):237–43.

    Google Scholar 

  41. Arase Y, Kobayashi M, Suzuki F, Suzuki Y, Kawamura Y, Akuta N, et al. Effect of type 2 diabetes on risk for malignancies includes hepatocellular carcinoma in chronic hepatitis C. Hepatology. 2013;57(3):964–73.

    Article  CAS  PubMed  Google Scholar 

  42. Huang YW, Yang SS, Fu SC, Wang TC, Hsu CK, Chen DS, et al. Increased risk of cirrhosis and its decompensation in chronic hepatitis C patients with new onset diabetes: a nationwide cohort study. Hepatology. 2014;60:807–14.

    Article  PubMed  Google Scholar 

  43. Chao LT, Wu CF, Sung FY, Lin CL, Liu CJ, Huang CJ, et al. Insulin, glucose and hepatocellular carcinoma risk in male hepatitis B carriers: results from 17-year follow-up of a population-based cohort. Carcinogenesis. 2011;32(6):876–81.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  44. Kawaguchi T, Taniguchi E, Morita Y, Shirachi M, Tateishi I, Nagata E, et al. Association of exogenous insulin or sulphonylurea treatment with an increased incidence of hepatoma in patients with hepatitis C virus infection. Liver Int: Off J Int Assoc Study Liver. 2010;30(3):479–86.

    Article  CAS  Google Scholar 

  45. Donadon V, Balbi M, Ghersetti M, Grazioli S, Perciaccante A, Della Valentina G, et al. Antidiabetic therapy and increased risk of hepatocellular carcinoma in chronic liver disease. World J Gastroenterol. 2009;15(20):2506–11.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  46. Donadon V, Balbi M, Mas MD, Casarin P, Zanette G. Metformin and reduced risk of hepatocellular carcinoma in diabetic patients with chronic liver disease. Liver Int: Off J Int Assoc Study Liver. 2010;30(5):750–8.

    Article  CAS  Google Scholar 

  47. Harris K, Smith L. Safety and efficacy of metformin in patients with type 2 diabetes mellitus and chronic hepatitis C. Ann Pharmacother. 2013;47(10):1348–52.

    Article  CAS  PubMed  Google Scholar 

  48. Nkontchou G, Cosson E, Aout M, Mahmoudi A, Bourcier V, Charif I, et al. Impact of metformin on the prognosis of cirrhosis induced by viral hepatitis C in diabetic patients. J Clin Endocrinol Metabol. 2011;96(8):2601–8.

    Article  CAS  Google Scholar 

  49. Zhang X, Harmsen WS, Mettler TA, Kim WR, Roberts RO, Therneau TM, et al. Continuation of metformin use after a diagnosis of cirrhosis significantly improves survival of patients with diabetes. Hepatology. 2014;60:2008–16.

    Article  CAS  PubMed  Google Scholar 

  50. Chaiteerakij R, Yang JD, Harmsen WS, Slettedahl SW, Mettler TA, Fredericksen ZS, et al. Risk factors for intrahepatic cholangiocarcinoma: association between metformin use and reduced cancer risk. Hepatology. 2013;57(2):648–55.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  51. Musso G, Cassader M, Rosina F, Gambino R. Impact of current treatments on liver disease, glucose metabolism and cardiovascular risk in non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of randomised trials. Diabetologia. 2012;55(4):885–904.

    Article  CAS  PubMed  Google Scholar 

  52. Sanyal AJ, Chalasani N, Kowdley KV, McCullough A, Diehl AM, Bass NM, et al. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. New Engl J Med. 2010;362(18):1675–85.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  53. Ratziu V, Giral P, Jacqueminet S, Charlotte F, Hartemann-Heurtier A, Serfaty L, et al. Rosiglitazone for nonalcoholic steatohepatitis: one-year results of the randomized placebo-controlled fatty liver improvement with rosiglitazone therapy (FLIRT) trial. Gastroenterology. 2008;135(1):100–10.

    Article  CAS  PubMed  Google Scholar 

  54. Scheen AJ. Pharmacokinetics in patients with chronic liver disease and hepatic safety of incretin-based therapies for the management of type 2 diabetes mellitus. Clin Pharmacokinet. 2014;53:773–85.

    Article  CAS  PubMed  Google Scholar 

  55. Kahal H, Abouda G, Rigby AS, Coady AM, Kilpatrick ES, Atkin SL. Glucagon-like peptide-1 analogue, liraglutide, improves liver fibrosis markers in obese women with polycystic ovary syndrome and nonalcoholic fatty liver disease. Clin Endocrinol. 2014;81:523–8.

    Article  CAS  Google Scholar 

  56. Eguchi Y, Kitajima Y, Hyogo H, Takahashi H, Kojima M, Ono M, et al. Pilot study of liraglutide effects in non-alcoholic steatohepatitis and non-alcoholic fatty liver disease with glucose intolerance in Japanese patients (LEAN-J). Hepatol Res: Off J Jpn Soc Hepatol. 2014.

    Google Scholar 

  57. D’Amico E. Efficacy of liraglutide in a patient with type 2 diabetes and cryptogenic cirrhosis. Acta bio-medica: Atenei Parmensis. 2011;82(2):160–1.

    Google Scholar 

  58. Arase Y, Kawamura Y, Seko Y, Kobayashi M, Suzuki F, Suzuki Y, et al. Efficacy and safety in sitagliptin therapy for diabetes complicated by non-alcoholic fatty liver disease. Hepatol Res: Off J Jpn Soc Hepatol. 2013;43(11):1163–8.

    Article  CAS  Google Scholar 

  59. Iwasaki T, Yoneda M, Inamori M, Shirakawa J, Higurashi T, Maeda S, et al. Sitagliptin as a novel treatment agent for non-alcoholic fatty liver disease patients with type 2 diabetes mellitus. Hepatogastroenterol. 2011;58(112):2103–5.

    Article  CAS  Google Scholar 

  60. Kutoh E. Probable linagliptin-induced liver toxicity: a case report. Diabetes Metab. 2014;40(1):82–4.

    Article  CAS  PubMed  Google Scholar 

  61. Giorda CB, Nada E, Tartaglino B. Pharmacokinetics, safety, and efficacy of DPP-4 inhibitors and GLP-1 receptor agonists in patients with type 2 diabetes mellitus and renal or hepatic impairment. A systematic review of the literature. Endocrine. 2014;46(3): 406–19.

    Article  CAS  PubMed  Google Scholar 

  62. Llach J, Gines P, Arroyo V, Rimola A, Tito L, Badalamenti S, et al. Prognostic value of arterial pressure, endogenous vasoactive systems, and renal function in cirrhotic patients admitted to the hospital for the treatment of ascites. Gastroenterology. 1988;94(2):482–7.

    CAS  PubMed  Google Scholar 

  63. Gomez EV, Gonzalez AT, Bertot LC, Yasells Garcia A, Rodriguez YS, Perez YM. Arterial blood pressure is closely related to ascites development in compensated HCV-related cirrhosis. PloS One. 2014;9(4):e95736.

    Article  PubMed  Google Scholar 

  64. Ge PS, Runyon BA. The changing role of beta-blocker therapy in patients with cirrhosis. J Hepatol. 2014;60(3):643–53.

    Article  CAS  PubMed  Google Scholar 

  65. Krag A, Bendtsen F, Henriksen JH, Moller S. Low cardiac output predicts development of hepatorenal syndrome and survival in patients with cirrhosis and ascites. Gut. 2010;59(1):105–10.

    Article  CAS  PubMed  Google Scholar 

  66. Runyon BA, Aasld. Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology. 2013;57(4):1651–3.

    Article  PubMed  Google Scholar 

  67. European Association for the Study of the L. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol. 2010;53(3):397–417.

    Article  Google Scholar 

  68. Leise MD, Talwalkar JA. Immunizations in chronic liver disease: what should be done and what is the evidence. Curr Gastroenterol Rep. 2013;15(1):300.

    Article  PubMed  Google Scholar 

  69. Leber B, Spindelboeck W, Stadlbauer V. Infectious complications of acute and chronic liver disease. Semin Respir Crit Care Med. 2012;33(1):80–95.

    Article  PubMed  Google Scholar 

  70. Danziger-Isakov L, Kumar D, Practice ASTIDCo. Vaccination in solid organ transplantation. Am J Transplant: Off J Am Soc Transplant Am Soc Transplant Surg. 2013;13 (Suppl 4):311–7.

    Article  CAS  Google Scholar 

  71. Rubin LG, Levin MJ, Ljungman P, Davies EG, Avery R, Tomblyn M, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis: Off Publ Infect Dis Soc Am. 2014;58(3):e44–100.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Section of Gastroenterology, Boston Medical Center, 85E Concord St, 02118, Boston, MA, USA

    David P. Nunes MD, FRCPI

  2. Mayo Clinic College of Medicine, Jacksonville, FL, USA

    Surakit Pungpapong MD

Authors
  1. David P. Nunes MD, FRCPI
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Surakit Pungpapong MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David P. Nunes MD, FRCPI .

Editor information

Editors and Affiliations

  1. Department of Transplant, Mayo Clinic, Jacksonville, Florida, USA

    Andrew P. Keaveny

  2. Institut de Malalties Digestives i Metaboliques, University of Barcelona, Barcelona, Spain

    Andrés Cárdenas

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Nunes, D., Pungpapong, S. (2015). Promoting a Healthy Lifestyle, Managing Hyperlipidemia, Diabetes Mellitus, Hypertension, and Immunizations in Patients with Cirrhosis. In: Keaveny, A., Cárdenas, A. (eds) Complications of Cirrhosis. Springer, Cham. https://doi.org/10.1007/978-3-319-13614-1_29

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-13614-1_29

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-13613-4

  • Online ISBN: 978-3-319-13614-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation