Which of the following is NOT a cause of malnutrition in a patient with liver disease?

• A. Reduced energy expenditure
• B. Malabsorption
• C. Decreased caloric intake
• D. Abnormal fuel metabolism

Answer: (A)

Malnutrition in liver disease primarily arises from not getting enough usable energy due to intake issues, problems with absorption, and the way the liver messes with fuel metabolism. Reduced energy expenditure, on the other hand, does not drive malnutrition; energy needs in cirrhosis are often normal or even higher because of systemic inflammation and altered metabolism. So the lack of nutrition is more about not getting or absorbing enough calories and nutrients and about how the diseased liver alters how those nutrients are processed, rather than a simple reduction in energy use. In this context, decreased caloric intake and malabsorption and abnormal fuel metabolism are all plausible contributors to malnutrition, whereas reduced energy expenditure is not.