1
|
Reuter B, Shaw J, Hanson J, Tate V, Acharya C, Bajaj JS. Nutritional Assessment in Inpatients With Cirrhosis Can Be Improved After Training and Is Associated With Lower Readmissions. Liver Transpl 2019; 25:1790-1799. [PMID: 31301208 PMCID: PMC7262968 DOI: 10.1002/lt.25602] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 06/30/2019] [Indexed: 12/23/2022]
Abstract
Malnutrition is widely prevalent in cirrhosis patients, which can worsen sarcopenia, hepatic encephalopathy (HE), and overall prognosis. We aimed to define the frequency of nutritional assessments of patients with cirrhosis in retrospective and prospective (after educational training) cohorts and to evaluate prospective changes along with their effects on 90-day readmissions. This study was conducted in 2 phases. Retrospectively, records of hospitalized patients with cirrhosis from the university and Veterans Affairs Medical Center (VAMC) settings were reviewed to assess nutritional status, if a nutrition consultation occurred, the number of days patients were nil per os (npo) and received inadequate nutrition, and if nutritional management was guideline directed. In the prospective phase, after dedicated educational efforts directed at the stakeholders regarding nutritional guidelines for patients with cirrhosis, subsequently hospitalized cirrhosis patients had nutritional and 90-day readmission data collected for comparison between groups. In total, 279 patients were included in the retrospective phase (150 university/129 VAMC), and 102 VAMC patients were in the prospective phase. Cirrhosis severity, reason for admission, and hospital course were similar between groups regardless of cohort, ie, prospective versus retrospective or VAMC versus university. The prospective group had significantly more nutritional consultations and assessments (74.5% versus 40.1%; P < 0.001) compared with the retrospective group regardless of comparisons between the VAMC and university cohorts. Both groups had a similar number of days npo, but the prospective group had fewer days of inadequate nutrition. The 90-day readmission rate was significantly lower in the prospective group versus the retrospective group (39.4% versus 28.4%; P = 0.04), which was associated with greater nutrition outpatient follow-up. In conclusion, nutritional consultation rates in inpatients with cirrhosis can be significantly improved after educational intervention and is associated with lower 90-day readmission rates.
Collapse
Affiliation(s)
- Bradley Reuter
- Department of Medicine, Hepatology and Nutrition, Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, VA
| | - Jawaid Shaw
- Department of Medicine, Hepatology and Nutrition, Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, VA
| | - Jennifer Hanson
- Department of Nutrition, Hepatology and Nutrition, Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, VA
| | - Victoria Tate
- Department of Nutrition, Hepatology and Nutrition, Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, VA
| | - Chathur Acharya
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, VA
| | - Jasmohan S. Bajaj
- Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire Veterans Affairs Medical Center, Richmond, VA
| |
Collapse
|
2
|
Kuftinec G, Ram Bhamidimarri K, Pearlman M. Malnutrition in Cirrhosis: Frequent but Overlooked. Liver Transpl 2019; 25:1743-1744. [PMID: 31609074 DOI: 10.1002/lt.25660] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/10/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Gabriela Kuftinec
- Department of Medicine, Division of Gastroenterology and Hepatology, Miller School of Medicine, University of Miami, Miami, FL
| | - Kalyan Ram Bhamidimarri
- Department of Medicine, Division of Gastroenterology and Hepatology, Miller School of Medicine, University of Miami, Miami, FL
| | - Michelle Pearlman
- Department of Medicine, Division of Gastroenterology and Hepatology, Miller School of Medicine, University of Miami, Miami, FL
| |
Collapse
|
3
|
Plauth M, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, Bischoff SC. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr 2019; 38:485-521. [PMID: 30712783 DOI: 10.1016/j.clnu.2018.12.022] [Citation(s) in RCA: 250] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 12/18/2018] [Indexed: 02/06/2023]
Abstract
This update of evidence-based guidelines (GL) aims to translate current evidence and expert opinion into recommendations for multidisciplinary teams responsible for the optimal nutritional and metabolic management of adult patients with liver disease. The GL was commissioned and financially supported by ESPEN. Members of the guideline group were selected by ESPEN. We searched for meta-analyses, systematic reviews and single clinical trials based on clinical questions according to the PICO format. The evidence was evaluated and used to develop clinical recommendations implementing the SIGN method. A total of 85 recommendations were made for the nutritional and metabolic management of patients with acute liver failure, severe alcoholic steatohepatitis, non-alcoholic fatty liver disease, liver cirrhosis, liver surgery and transplantation as well as nutrition associated liver injury distinct from fatty liver disease. The recommendations are preceded by statements covering current knowledge of the underlying pathophysiology and pathobiochemistry as well as pertinent methods for the assessment of nutritional status and body composition.
Collapse
Affiliation(s)
- Mathias Plauth
- Department of Internal Medicine, Municipal Hospital of Dessau, Dessau, Germany.
| | - William Bernal
- Institute of Liver Studies, King's College Hospital, London, United Kingdom
| | - Srinivasan Dasarathy
- Division of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, OH, USA
| | - Manuela Merli
- Gastroenterology and Hepatology Unit, Sapienza University of Rome, Rome, Italy
| | - Lindsay D Plank
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - Tatjana Schütz
- IFB Adiposity Diseases, Leipzig University Medical Centre, Leipzig, Germany
| | - Stephan C Bischoff
- Department for Clinical Nutrition, University of Hohenheim, Stuttgart, Germany
| |
Collapse
|
4
|
|
5
|
[Nutrition in intensive care medicine: Part 2: special nutritional problems]. Anaesthesist 2013; 62:233-41; quiz 242-3. [PMID: 23483230 DOI: 10.1007/s00101-012-2011-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Therapy of intensive care patients is often complicated by co-morbidities or complex systemic disorders such as sepsis. The necessity to generate an individualized nutritional regime has gained in importance in recent years as this essential part of supportive care has a direct impact on the prognosis of the patient. In the present article a special focus is put on particular questions of nutritional aspects of intensive care patients. The current guidelines and study data on disorders relevant in intensive care medicine, such as acute or chronic renal and liver failure, acute respiratory distress syndrome and sepsis are presented and discussed. Another focus is the establishment of an adequate nutritional regime for patients after operations or suffering from multiple trauma.
Collapse
|
6
|
Abstract
The dietary intake of patients with nonalcoholic fatty liver disease (NAFLD) is generally characterized by high levels of carbohydrate, fat, and/or cholesterol, and these dietary patterns influence hepatic lipid metabolism in the patients. Therefore, careful investigation of dietary habits could lead to better nutrition therapy in NAFLD patients. The main treatment for chronic hepatitis C (CHC) is interferon-based antiviral therapy, which often causes a decrease in appetite and energy intake; hence, nutritional support is also required during therapy to prevent undernourishment, treatment interruption, and a reduction in quality of life. Moreover, addition of some nutrients that act to suppress viral proliferation is recommended. As a substitutive treatment, low-iron diet therapy, which is relatively safe and effective for preventing hepatocellular carcinoma, is also recommended for CHC patients. Some patients with liver cirrhosis (LC) have decreased dietary energy and protein intake, while the number of LC patients with overeating and obesity is increasing, indicating that the nutritional state of LC patients has a broad spectrum. Therefore, nutrition therapy for LC patients should be planned on an assessment of their complications, nutritional state, and dietary intake. Late evening snacks, branched-chain amino acids, zinc, and probiotics are considered for effective nutritional utilization.
Collapse
|
7
|
Higgins G, O'Brien JR, Peters RA, Stewart A, Witts LJ. Treatment of Infective Hepatitis with Methionine. BRITISH MEDICAL JOURNAL 2011; 1:401-2. [PMID: 20785971 DOI: 10.1136/bmj.1.4394.401] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
8
|
Darmady EM. Effects of Protein Diet on Infective Hepatitis. BRITISH MEDICAL JOURNAL 2011; 1:795-7. [PMID: 20786109 DOI: 10.1136/bmj.1.4405.795] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
9
|
György P, Goldblatt H. OBSERVATIONS ON THE CONDITIONS OF DIETARY HEPATIC INJURY (NECROSIS, CIRRHOSIS) IN RATS. ACTA ACUST UNITED AC 2010; 75:355-68. [PMID: 19871189 PMCID: PMC2135254 DOI: 10.1084/jem.75.4.355] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Experimental dietary hepatic injury (diffuse or focal necrosis and cirrhosis in rats, with or without ascites and pleural and pericardial effusion) is determined by the dietary factors instrumental also in the production of fat infiltration of the liver and thus opposed to the lipotropic activity of casein. Accordingly, rats maintained on a diet low in casein with a moderately high or high content of fat and without choline regularly exhibited hepatic injury after between 100 and 150 days. Supplements of l-cystine had an aggravating effect on the production of cirrhosis of the liver, whereas a supplement of choline alone reduced the severity and the incidence of hepatic injury, although not decisively. The combined administration of l-cystine plus choline or of dl-methionine in adequate doses, however, proved to be highly effective in preventing injury to the liver. These conclusions have been corroborated by the use of different modifications of the basal diet. Rats with dietary hepatic injury exhibit, in sequence, changes that vary from diffuse necrosis resembling human acute or subacute yellow atrophy to advanced portal cirrhosis. Diffuse necrotizing nephrosis was a frequent accompaniment of the hepatic injury. Cystine again, proved to be a factor which aggravated this condition.
Collapse
Affiliation(s)
- P György
- Babies and Childrens Hospital, the Institute of Pathology, and the Departments of Pediatrics and Pathology, School of Medicine, Western Reserve University, Cleveland
| | | |
Collapse
|
10
|
Yamanaka-Okumura H, Nakamura T, Miyake H, Takeuchi H, Katayama T, Morine Y, Imura S, Shimada M, Takeda E. Effect of long-term late-evening snack on health-related quality of life in cirrhotic patients. Hepatol Res 2010; 40:470-6. [PMID: 20412329 DOI: 10.1111/j.1872-034x.2010.00637.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM In patients with liver cirrhosis, abnormal energy metabolism induces low health-related quality of life (HRQOL) scores. However, late-evening snack (LES) prevents morning starvation in cirrhotic patients. Our aim is to assess the effect of long-term LES on HRQOL in cirrhotic patients, using the 36-item Short Form (SF-36) health survey. METHODS Thirty-nine cirrhotic patients classified as Child-Pugh grade A were recruited. The patients were randomly divided into two groups: 24 were assigned to the non-LES group and 15 to the LES group. SF-36 scores, anthropometric data and serum biochemical parameters were examined in the non-LES and LES groups at 0, 6 and 12 months. RESULTS Neither anthropometric data nor laboratory data showed significant differences between the non-LES and the LES groups at 0, 6 and 12 months. The role-emotional (RE) HRQOL scores at 6 months and mental health (MH) scores at 6 and 12 months were significantly reduced from the baseline level in the non-LES group. In contrast, these scores remained unchanged in the LES group. General health perception (GH) scores at 12 months, RE at 6 months and MH at 6 and 12 months in the LES group were significantly higher than those of the non-LES group. CONCLUSION Long-term LES administration may be helpful in maintaining higher HRQOL in patients with cirrhosis.
Collapse
Affiliation(s)
- Hisami Yamanaka-Okumura
- Department of Clinical Nutrition, Institute of Health Biosciences, University of Tokushima Graduate School, Tokushima, Tokushima, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
11
|
WITTS LJ. A review of the dietetic factors in liver disease; the application of nutritional principles in treatment. BRITISH MEDICAL JOURNAL 2010; 1:45-9. [PMID: 20278520 DOI: 10.1136/bmj.1.4488.45] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
12
|
SELLERS EA, LUCAS CC, BEST CH. The lipotropic factors in experimental cirrhosis. BRITISH MEDICAL JOURNAL 2008; 1:1061-5. [PMID: 18864152 DOI: 10.1136/bmj.1.4561.1061] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
13
|
Plauth M, Merli M, Kondrup J, Weimann A, Ferenci P, Müller MJ. ESPEN guidelines for nutrition in liver disease and transplantation. Clin Nutr 2007; 16:43-55. [PMID: 16844569 DOI: 10.1016/s0261-5614(97)80022-2] [Citation(s) in RCA: 212] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- M Plauth
- IV. Medizinische Klinik, Klinikum Charitéder Humboldt Universität, D-10098 Berlin, Germany
| | | | | | | | | | | |
Collapse
|
14
|
|
15
|
Thorn GW, Armstrong SH, Davenport VD. CHEMICAL, CLINICAL, AND IMMUNOLOGICAL STUDIES ON THE PRODUCTS OF HUMAN PLASMA FRACTIONATION. XXXI. THE USE OF SALT-POOR CONCENTRATED HUMAN SERUM ALBUMIN SOLUTION IN THE TREATMENT OF HEPATIC CIRRHOSIS. J Clin Invest 2006; 25:304-23. [PMID: 16695321 PMCID: PMC435567 DOI: 10.1172/jci101711] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- G W Thorn
- Department of Medicine, Harvard Medical School, Boston
| | | | | |
Collapse
|
16
|
Haig C, Patek AJ. VITAMIN A DEFICIENCY IN LAENNEC'S CIRRHOSIS. THE RELATIVE SIGNIFICANCE OF THE PLASMA VITAMIN A AND CAROTENOID LEVELS AND THE DARK ADAPTATION TIME. J Clin Invest 2006; 21:309-17. [PMID: 16694917 PMCID: PMC435145 DOI: 10.1172/jci101305] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- C Haig
- Research Service, First Medical Division, Welfare Hospital, New York City Department of Hospitals, New York City
| | | |
Collapse
|
17
|
Ralli EP, Robson JS, Clarke D, Hoagland CL. FACTORS INFLUENCING ASCITES IN PATIENTS WITH CIRRHOSIS OF THE LIVER. J Clin Invest 2006; 24:316-25. [PMID: 16695218 PMCID: PMC435460 DOI: 10.1172/jci101608] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- E P Ralli
- Department of Medicine, New York University College of Medicine, New York City
| | | | | | | |
Collapse
|
18
|
Faloon WW, Eckhardt RD, Cooper AM, Davidson CS. THE EFFECT OF HUMAN SERUM ALBUMIN, MERCURIAL DIURETICS, AND A LOW SODIUM DIET ON SODIUM EXCRETION IN PATIENTS WITH CIRRHOSIS OF THE LIVER. J Clin Invest 2006; 28:595-602. [PMID: 16695716 PMCID: PMC439640 DOI: 10.1172/jci102109] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- W W Faloon
- Thorndike Memorial Laboratory, Second and Fourth Medical Services [Harvard], Boston City Hospital, Boston
| | | | | | | |
Collapse
|
19
|
Klatskin G, Yesner R. FACTORS IN THE TREATMENT OF LAENNEC'S CIRRHOSIS. I. CLINICAL AND HISTOLOGICAL CHANGES OBSERVED DURING A CONTROL PERIOD OF BED-REST, ALCOHOL WITH-DRAWAL, AND A MINIMAL BASIC DIET. J Clin Invest 2006; 28:723-35. [PMID: 16695731 PMCID: PMC439655 DOI: 10.1172/jci102124] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- G Klatskin
- Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn
| | | |
Collapse
|
20
|
Eckhardt RD, Faloon WW, Davidson CS. IMPROVEMENT OF ACTIVE LIVER CIRRHOSIS IN PATIENTS MAINTAINED WITH AMINO ACIDS INTRAVENOUSLY AS THE SOURCE OF PROTEIN AND LIPOTROPIC SUBSTANCES. J Clin Invest 2006; 28:603-14. [PMID: 16695717 PMCID: PMC439641 DOI: 10.1172/jci102110] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- R D Eckhardt
- Thorndike Memorial Laboratory, Second and Fourth Medical Services [Harvard], Boston City Hospital, Boston
| | | | | |
Collapse
|
21
|
Mankin H, Lowell A. OSMOTIC FACTORS INFLUENCING THE FORMATION OF ASCITES IN PATIENTS WITH CIRRHOSIS OF THE LIVER. J Clin Invest 2006; 27:145-53. [PMID: 16695525 PMCID: PMC439483 DOI: 10.1172/jci101917] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- H Mankin
- Research Service, First [Columbia] Division, Goldwater Memorial Hospital, New York City
| | | |
Collapse
|
22
|
Iwasa M, Iwata K, Kaito M, Ikoma J, Yamamoto M, Takeo M, Kuroda M, Fujita N, Kobayashi Y, Adachi Y. Efficacy of long-term dietary restriction of total calories, fat, iron, and protein in patients with chronic hepatitis C virus. Nutrition 2005; 20:368-71. [PMID: 15043853 DOI: 10.1016/j.nut.2003.12.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES A diet restrictive in total calories, fat, iron, and protein intake reduces serum alanine aminotransferase levels in patients with long-term hepatitis C virus infection. However, whether long-term dietary therapy causes adverse effects such as malnutrition and anemia due to a shortage of energy intake is not clear. We evaluated the balance of energy intake and changes in physical and hematologic indices of nutrition after a long-term dietary therapy. METHODS Twenty-two patients with long-term hepatitis C virus infection that did not respond to or who were able or unwilling to take interferon therapy were enrolled in this study. Our prescriptions included 7 mg/d or less of iron, 30 kcal. kg(-1). d(-1) of energy, 1.1 to 1.2 g. kg(-1). d(-1) of protein, and a fat energy fraction of 20%. Patients were followed for 24 mo. RESULTS Mean body fat percentage was 24.6% at entry and was significantly reduced after the diet prescription. Mean serum ferritin decreased significantly from 376 ng/mL at entry to 141 ng/mL after 24 mo. Mean serum alanine aminotransferase levels decreased significantly from 66 to 49 IU/L. Mean levels of hemoglobin, serum albumin, and cholinesterase did not change significantly during the follow-up period. CONCLUSIONS These results suggest that restriction of energy, fat, iron, and protein intakes is safely tolerated, so its long-term use should be recommended to patients with long-term infection with hepatitis C virus.
Collapse
Affiliation(s)
- Motoh Iwasa
- Third Department of Internal Medicine, Mie University School of Medicine, Tsu, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
23
|
ECKHARDT RD, ZAMCHECK N. Effect of protein starvation and of protein feeding on the clinical course, liver function and liver histochemistry of three patients with active fatty alcoholic cirrhosis. J Clin Invest 2004; 29:227-37. [PMID: 15403987 PMCID: PMC439744 DOI: 10.1172/jci102250] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
24
|
PHILLIPS GB, GABUZDA GJ, DAVIDSON CS. Comparative effects of a purified and an adequate diet on the course of fatty cirrhosis in the alcoholic. J Clin Invest 2004; 31:351-6. [PMID: 14917753 PMCID: PMC436425 DOI: 10.1172/jci102615] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
25
|
|
26
|
|
27
|
Amodio P, Caregaro L, Pattenò E, Marcon M, Del Piccolo F, Gatta A. Vegetarian diets in hepatic encephalopathy: facts or fantasies? Dig Liver Dis 2001; 33:492-500. [PMID: 11572577 DOI: 10.1016/s1590-8658(01)80028-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Diet treatment characterized by a reduction in or a selection of food proteins is currently suggested in hepatic encephalopathy. This article is a review of the present knowledge about the characteristics and the rationale of vegetarian diets in cirrhotic patients with overt or latent encephalopathy. In addition, evidence relating diet and encephalopathy and the nutritional features and needs of cirrhotic patients is reported. Finally, the rationale of a diet based on vegetable and milk-derived proteins that may overcome the limits and the possible adverse effects of a strict vegetarian diet is presented.
Collapse
Affiliation(s)
- P Amodio
- Dept Medicine V, Clinical Nutrition, University of Padua, Italy.
| | | | | | | | | | | |
Collapse
|
28
|
|
29
|
Mendenhall CL, Moritz TE, Roselle GA, Morgan TR, Nemchausky BA, Tamburro CH, Schiff ER, McClain CJ, Marsano LS, Allen JI. A study of oral nutritional support with oxandrolone in malnourished patients with alcoholic hepatitis: results of a Department of Veterans Affairs cooperative study. Hepatology 1993; 17:564-76. [PMID: 8477961 DOI: 10.1002/hep.1840170407] [Citation(s) in RCA: 228] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A Veterans Affairs cooperative study involving 273 male patients was performed to evaluate efficacy of oxandrolone in combination with an enteral food supplement in severe alcoholic hepatitis. All patients had some degree of protein calorie malnutrition. On an intention-to-treat basis, only minimal changes in mortality were observed. However, in patients with moderate malnutrition mortality on active treatment at 1 mo was 9.4% compared with 20.9% in patients receiving placebo. This beneficial effect was maintained so that after 6 mo on active treatment 79.7% of patients were still alive, compared with 62.7% of placebo-treated patients (p = 0.037). Improvements in both the severity of the liver injury (p = 0.03) and malnutrition (p = 0.05) also occurred. No significant improvement was observed with severe malnutrition. To better determine the effect on therapeutic efficacy, we compared results with those from a nearly identical population (cooperative study 119) treated with oxandrolone but not given the food supplement. Patients were stratified according to their caloric intake (greater than 2,500 kcal/day was considered adequate to supply energy needs and promote anabolism). For patients with moderate malnutrition and adequate caloric intake, oxandrolone treatment reduced 6-mo mortality (4% active treatment vs. 28% placebo [p = 0.002]). For patients with moderate malnutrition and inadequate calorie intake, oxandrolone had no effect on mortality (30% active treatment vs. 33% placebo). In cases of severe malnutrition, oxandrolone had no effect on survival. However, adequate caloric intake was associated with 19% mortality, whereas patients with inadequate intake exhibited 51% mortality (p = 0.0001). These results indicate that nutritional status should be evaluated in patients with alcoholic hepatitis. When malnutrition is present, vigorous nutrition therapy should be provided, and in patients with moderate malnutrition oxandrolone should be added to the regimen.
Collapse
Affiliation(s)
- C L Mendenhall
- Department of Veterans Affairs Medical Center, Cincinnati, Ohio 45220
| | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
|
31
|
Abstract
Liver injury may develop in some people who consume alcohol. The pathogenesis of liver damage in such subjects remains obscure. Major histopathologic features of alcohol-associated liver injury include steatosis, steatonecrosis, and cirrhosis. The clinical manifestations of alcoholic liver disease are nonspecific and range from asymptomatic hepatomegaly to stigmata of portal hypertension with advanced parenchymal failure. The severity of the clinical presentation and the degree of aminotransferase elevation correlate poorly with the liver histopathology, particularly in patients who continue to drink alcohol. Short-term mortality of such patients is best predicted by a composite of clinical and laboratory parameters that are influenced by alcohol consumption as well as by liver disease. Long-term prognosis is determined by residual damage to vital organs (that is, whether or not cirrhosis has developed) and whether or not the patient continues to drink. Current therapy of alcoholic liver disease includes abstinence and correction of nutritional deficiencies. Other therapies are experimental and are best utilized in the setting of controlled clinical trials.
Collapse
Affiliation(s)
- A M Diehl
- Gastroenterology-Hepatology Division, Georgetown University, Washington DC
| |
Collapse
|
32
|
Affiliation(s)
- M Y Morgan
- Academic Department of Medicine, Royal Free Hospital, School of Medicine, Hampstead, London
| | | |
Collapse
|
33
|
|
34
|
Mendenhall CL, Anderson S, Weesner RE, Goldberg SJ, Crolic KA. Protein-calorie malnutrition associated with alcoholic hepatitis. Veterans Administration Cooperative Study Group on Alcoholic Hepatitis. Am J Med 1984; 76:211-22. [PMID: 6421159 DOI: 10.1016/0002-9343(84)90776-9] [Citation(s) in RCA: 248] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Three hundred sixty-three alcoholic patients with alcoholic hepatitis were studied in six Veterans Administration medical centers. By history, alcohol consumption was 227.9 g per day, with a mean duration of 23.8 years. Cirrhosis accompanied the alcoholic hepatitis in 58.7 percent of the patients who underwent biopsy or autopsy. Complete nutritional assessment was performed in 284 patients, and observed nutritional changes were classified into those associated with marasmus or those characterizing kwashiorkor. A smaller comparison group of 21 alcoholic patients matched for age and alcohol consumption but without clinically evident liver disease was also studied in an identical manner. None of the patients with liver disease was completely free from malnutrition, whereas 62 percent of the alcoholic patients without liver disease showed abnormalities. In patients with alcoholic hepatitis, some findings associated with marasmus were seen in 86 percent, and some features of kwashiorkor were observed in 100 percent. When present together, the complete picture of kwashiorkor and marasmus correlated closely with the clinical severity of the liver disease (p less than 0.005). The nearly constant association of either complete or partial kwashiorkor or marasmus suggests that the separation of these two entities is artificial in alcoholic patients with liver disease. Although, experimentally, malnutrition may not be essential for the development of alcoholic hepatitis, clinically, it appears to precede the development of the liver injury, which suggests an interaction. Recognition is important so that appropriate nutritional therapy can be provided.
Collapse
|
35
|
|
36
|
|
37
|
|
38
|
Rankin JR, Wilkinson P, Santamaria JN. Factors influencing the prognosis of the alcoholic patient with cirrhosis. AUSTRALASIAN ANNALS OF MEDICINE 1970; 19:232-9. [PMID: 5470974 DOI: 10.1111/imj.1970.19.3.232] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
|
39
|
Porta EA, Koch OR, Hartroft WS. Recent advances in molecular pathology: a review of the effects of alcohol on the liver. Exp Mol Pathol 1970; 12:104-32. [PMID: 4392309 DOI: 10.1016/0014-4800(70)90078-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
40
|
Powell WJ, Klatskin G. Duration of survival in patients with Laennec's cirrhosis. Influence of alcohol withdrawal, and possible effects of recent changes in general management of the disease. Am J Med 1968; 44:406-20. [PMID: 5641303 DOI: 10.1016/0002-9343(68)90111-3] [Citation(s) in RCA: 204] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
41
|
|
42
|
|
43
|
PATEK AJ. Dietary factors in the pathogenesis and treatment of cirrhosis of the liver. Med Clin North Am 1963; 47:753-63. [PMID: 13941783 DOI: 10.1016/s0025-7125(16)33576-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
44
|
|
45
|
|
46
|
ADLERCREUTZ E. Intraperitoneal infusion of ultrafiltered ascites in decompensated cirrhosis of the liver; preliminary investigation. I. ACTA MEDICA SCANDINAVICA 1958; 161:1-8. [PMID: 13532480 DOI: 10.1111/j.0954-6820.1958.tb15516.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
47
|
|
48
|
SBOROV VM. Diet and nutritional aids in liver disease. Dig Dis Sci 1958; 3:94-102. [PMID: 13497977 DOI: 10.1007/bf02232382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
49
|
|
50
|
SUMMERSKILL WH, WOLFE SJ, DAVIDSON CS. Response to alcohol in chronic alcoholics with liver disease; clinical, pathological, and metabolic changes. Lancet 1957; 272:335-40. [PMID: 13407007 DOI: 10.1016/s0140-6736(57)90402-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|