What lifestyle modifications should I recommend to patients with chronic liver disease to improve their prognosis?

Lifestyle modifications recommended for patients with chronic liver disease to improve prognosis include:

• Alcohol abstinence: Patients with cirrhosis from any cause should abstain from alcohol as this improves outcomes at all stages of alcohol-related liver disease.
• Weight management: Encourage gradual, sustained weight loss especially in overweight or obese patients, aiming for 5-10% weight loss over 6 months to reduce liver fat and risk of disease progression.
• Physical activity: Advise regular moderate-intensity exercise (150-200 minutes per week in 3-5 sessions) including muscle-strengthening exercises to reduce sarcopenia and improve muscle mass, strength, and function.
• Nutrition: Assess and manage malnutrition by ensuring adequate protein, energy, and micronutrient intake, ideally with dietitian input, to reduce risk of hepatic encephalopathy and complications.
• Smoking cessation: Advise patients to stop smoking to reduce additional health risks.
• Bone health: Assess fracture risk and ensure adequate calcium and vitamin D intake to prevent osteoporosis and fragility fractures.
• Immunizations: Ensure patients are up-to-date with vaccinations (e.g., influenza, pneumococcal, hepatitis B, COVID-19) due to immunosuppression and increased infection risk.
• Medication review: Regularly review medications to avoid drugs that may worsen liver function or cause toxicity, and advise patients to seek medical advice before taking over-the-counter or herbal remedies.

These lifestyle modifications should be supported by appropriate specialist follow-up and monitoring for complications.

All recommendations are based on UK best practice guidelines and expert opinion.

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