The complex interaction between liver disease and food intake is not well defined. There are two aspects to consider: how liver disease affects food intake and whether or not diet can affect liver disease. Acute and chronic liver disease have been shown to influence taste, smell, food preference, and appetite. The liver may also play a role in food selection through reflex pathways. Intake of various macronutrients can alter serum liver enzymes and bilirubin without necessarily being associated with changes in pre-existing liver disease. Nonetheless, there is evidence that diet can be associated with both adverse and beneficial changes in outcome in animal models and patients with liver disease. These issues are difficult to unravel; however, there is potential for significant clinical advances from examining this area.