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Dietary and nutritional indications in hepatic encephalopathy.
Metab Brain Dis. 2009 Mar; 24(1):211-21.MB

Abstract

The restriction of dietary protein has long been considered a main stay in the therapy of hepatic encephalopathy. More recently it has been recognized that protein energy malnutrition is frequent in advanced liver disease and may adversely affect the patients'outcome. Moreover studies on inter-organ ammonia exchange in liver cirrhosis have shown that the muscle may have a crucial role in ammonia detoxification. In light of these evidences nutritional guidelines have proposed that protein restriction should be avoided in patients with hepatic encephalopathy as protein requirement is even increased in cirrhotic patients. Survey about the current clinical practice show that protein restriction is still considered advisable in patients with hepatic encephalopathy, however a recent trial evidenced that a low protein diet in patients hospitalized for acute hepatic encephalopathy exacerbates protein breakdown without inducing any specific clinical benefit when compared to a normal protein regimen. The relevance of an adequate protein intake and possible strategies to implement protein tolerance are also discussed.

Authors+Show Affiliations

II Gastroenterologia, Università degli Studi di Roma "La Sapienza", Rome, Italy. manuela.merli@uniroma1.itNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19052853

Citation

Merli, Manuela, and Oliviero Riggio. "Dietary and Nutritional Indications in Hepatic Encephalopathy." Metabolic Brain Disease, vol. 24, no. 1, 2009, pp. 211-21.
Merli M, Riggio O. Dietary and nutritional indications in hepatic encephalopathy. Metab Brain Dis. 2009;24(1):211-21.
Merli, M., & Riggio, O. (2009). Dietary and nutritional indications in hepatic encephalopathy. Metabolic Brain Disease, 24(1), 211-21. https://doi.org/10.1007/s11011-008-9127-0
Merli M, Riggio O. Dietary and Nutritional Indications in Hepatic Encephalopathy. Metab Brain Dis. 2009;24(1):211-21. PubMed PMID: 19052853.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Dietary and nutritional indications in hepatic encephalopathy. AU - Merli,Manuela, AU - Riggio,Oliviero, Y1 - 2008/12/04/ PY - 2008/04/02/received PY - 2008/10/28/accepted PY - 2008/12/5/pubmed PY - 2009/7/7/medline PY - 2008/12/5/entrez SP - 211 EP - 21 JF - Metabolic brain disease JO - Metab Brain Dis VL - 24 IS - 1 N2 - The restriction of dietary protein has long been considered a main stay in the therapy of hepatic encephalopathy. More recently it has been recognized that protein energy malnutrition is frequent in advanced liver disease and may adversely affect the patients'outcome. Moreover studies on inter-organ ammonia exchange in liver cirrhosis have shown that the muscle may have a crucial role in ammonia detoxification. In light of these evidences nutritional guidelines have proposed that protein restriction should be avoided in patients with hepatic encephalopathy as protein requirement is even increased in cirrhotic patients. Survey about the current clinical practice show that protein restriction is still considered advisable in patients with hepatic encephalopathy, however a recent trial evidenced that a low protein diet in patients hospitalized for acute hepatic encephalopathy exacerbates protein breakdown without inducing any specific clinical benefit when compared to a normal protein regimen. The relevance of an adequate protein intake and possible strategies to implement protein tolerance are also discussed. SN - 0885-7490 UR - https://www.unboundmedicine.com/medline/citation/19052853/Dietary_and_nutritional_indications_in_hepatic_encephalopathy_ L2 - https://doi.org/10.1007/s11011-008-9127-0 DB - PRIME DP - Unbound Medicine ER -