“Mistakes in the nutritional and lifestyle management of chronic liver disease and how to avoid them: A narrative review”

Nutrition, together with broader lifestyle modification, is central to managing chronic liver disease across its full spectrum, yet remains consistently underutilised. Despite clear guidelines and a robust evidence base, a measurable gap persists between what patients should receive and what they actually get. This narrative review examines ten nutritional mistakes, selected for their prevalence and direct impact on outcomes. In MASLD, common errors include sidelining lifestyle modification as pharmacological options expand and delivering generic dietary advice that ignores patient preferences, cultural context, and metabolic comorbidities. Alcohol counselling is frequently inadequate; despite evidence that even low-to-moderate intake drives fibrosis progression, patients with significant fibrosis require clear instruction to abstain entirely. Malnutrition affects the vast majority of hospitalised patients with alcohol-associated hepatitis, yet remains underrecognised. Deficiencies in thiamine, zinc, folate, and vitamins A, D, and E compound clinical risk. In cirrhosis, formal nutritional screening occurs in fewer than half of eligible patients. Malnutrition is wrongly accepted as an irreversible consequence of advanced disease, discouraging intervention. Low-protein diets continue to be prescribed for hepatic encephalopathy despite evidence of harm. Sarcopenia, present in up to 70% of cirrhotic patients and carrying an increased mortality, is routinely overlooked. Patients also receive overly restrictive guidance that reduces total intake rather than improving nutritional status. Pre-transplant nutritional assessment and prehabilitation remain inconsistently integrated into clinical care, despite evidence that malnutrition and sarcopenia independently predict post-transplant mortality beyond MELD score. For each mistake, this review outlines the evidence, explains why errors occur, and offers practical, guideline-concordant corrections.