Nutrition support of children with chronic liver disease: A rapid review and consensus statements from Australasian society of parenteral and enteral nutrition (AuSPEN) Paediatric liver group.

Chronic liver disease (CLD) in children is associated with high risk of malnutrition, micronutrient deficiencies, growth failure, and poor post-transplant outcomes. Although international 2019 guidelines exist, variability in practice across Australia and New Zealand (ANZ) highlights the need for locally relevant, updated nutritional guidance. This study aimed to conduct a rapid review of recent evidence (2018-2025) on the nutritional management of paediatric CLD and develop updated consensus statements to inform a best practice nutrition pathway for ANZ. A rapid review was conducted in accordance with PRISMA guidelines. Evidence tables were developed and appraised using National Health Medical Research Council (NHMRC) guidelines. Consensus statements were derived from the evidence tables, and voted on by all AuSPEN group members. Consensus was reached at 80% agreement. Of 1260 records screened, 67 full-text articles were included in the review, resulting in 19 evidence-informed consensus statements. Key areas included: proactive use of enteral and parenteral nutrition; cautious use of medium chain triglyceride (MCT) in context of potential essential fatty acid (EFA) deficiency; use of mid upper arm circumference (MUAC) and subjective global nutritional assessment (SGNA) for assessment; monitoring of sarcopenia; targeted support during post-transplant recovery and transition to adult care. Emerging topics included sarcopenia measurement and rehabilitation, and advancements in optimal nutrition management. This rapid review highlights both alignment with and advances upon 2019 international guidelines. The consensus statements provide a framework for best practice nutritional care of children with CLD across ANZ.