How is energy expenditure impacted in liver disease?

• A. Unchanged
• B. Variable
• C. Decreased
• D. Increased

Answer: (D)

In liver disease, energy expenditure tends to rise because the body shifts into a hypermetabolic, catabolic state driven by systemic inflammation, stress hormones, and increased proteolysis. Cytokines and cortisol promote protein breakdown and accelerated gluconeogenesis, which raises the energy cost of maintaining metabolism. Ascites and the extra work of breathing or activity from edema can further elevate energy needs. Even when intake is limited, the metabolic demand is often higher than what is provided, creating an energy deficit unless nutrition support compensates. While some individuals may show variability in REE, the overall trend in liver disease is increased energy expenditure, making increased the best answer.