The process of aging predisposes to hepatic functional and structural impairment and metabolic risk. There are no specific age-related liver diseases but some of them are particularly more frequent in the elderly population, such as nonalcoholic fatty liver disease (NALFD), chronic hepatitis C and hepatocellular carcinoma. NAFLD is the most common liver disease, affecting about 30% of the overall population. Clinically NAFLD tends to be associated with the most typical geriatric syndromes, such as dementia, sarcopenia, dysfunction of the autonomic nervous system. The nutrition therapy for chronic liver diseases should be planned on an assessment of their complications, nutritional state and dietary intake. Non-pharmacological treatment including diet and physical activity should be individually tailored considering the physical limitations, typical geriatric syndromes, such as frailty, multimorbidity, polypharmacy and dementia. For malnourished patients with chronic liver disease oral and enteral nutrition is recommended. Parenteral nutrition should be reserved for those with moderate-to-se- vere malnutrition who cannot meet their caloric needs by oral or enteral routes. Daily caloric ESPEN recommendations for patients with chronic liver disease ran ges from 35 - 40 kcal/kg/ day. Daily protein requirement is 1,0 - 1,5 g/kg/day, and in acute encephalopathy is 0,6 - 0,6 g/ kg/day. Small meals evenly distributed through the day and a bedtime snack of complex carbohydrates minimize muscle loss. Branched-chain amino acids (BAA) supplementation may help to achieve daily protein goals in patients who are protein intolerant. Sodium restriction, 80 - 120 mmol sodium/day is recommended in the therapy of ascites. Restriction of fluids is not recommended until serum level of sodium decreases to 120-125 mmol/l.
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