Table 1: Metabolic alterations leading to malnutrition in end-stage liver failure.

ProteinCarbohydrateFat

(i)  Increased  catabolism (ii)  Increased  utilization of BCAAs (iii)  Decreased  ureagenesis(i)  Decreased  hepatic  and  skeletal  muscle glycogen  synthesis
(ii)  Increased  gluconeogenesis (iii)  Glucose  intolerance  and  insulin resistance
(i)  Increased  lipolysis
(ii)  Enhanced  turnover  and  oxidation of fatty  acids
(iii)  Increased  Ketogenesis