Rationale: Chronic liver disease (CLD) in children significantly disrupts hepatic functions essential for maintaining nutritional homeostasis, notably the synthesis, storage, and metabolism of macro- and micronutrients. These impairments commonly result in protein-energy malnutrition and growth retardation, both of which contribute to heightened morbidity, delayed neurodevelopment, immune dysfunction, and unfavorable post-transplant outcomes. In this context, we conducted a retrospective descriptive study over a three-year period (November 2020 to November 2023) in a pediatric gastroenterology and nutrition department, aiming to evaluate the nutritional status of children with CLD and explore associations with underlying etiologies.

The study included 64 children aged 1 month to 13 years (mean age: 33.5 months; M: F sex ratio = 1.2). Data collection focused on anthropometric parameters (weight, height, BMI, Waterlow index, and mid-upper arm/head circumference ratio), clinical signs, biological markers (including albumin, total proteins, cholesterol, calcium, phosphorus, ferritin, and fat-soluble vitamins), and nutritional interventions. Malnutrition was identified in more than 80% of patients, with moderate to severe forms particularly prevalent among those with metabolic liver diseases and biliary cirrhosis. Clinically, the most frequently observed signs included pallor (49%), ascites (35%), edema (31%), and muscle wasting (20%), often masked by fluid retention. Biochemical abnormalities were also common, with hypoalbuminemia in 31%, hypoproteinemia in 35%, and vitamin D deficiency in 22% of cases. The predominant etiologies were biliary cirrhosis (39%)—notably biliary atresia—and metabolic liver diseases (35%).

Nutritional management primarily consisted of supplementation with fat-soluble vitamins (D in 76%, K in 80%, A and E in 68%), iron (52%), and the use of medium-chain triglyceride-enriched diets in cholestatic patients. The findings underscore the high prevalence of malnutrition in pediatric CLD, particularly in biliary and metabolic forms, and highlight the necessity of early, targeted nutritional assessment and intervention as an integral part of the comprehensive care strategy for these patients.