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Nutrition in hepatic encephalopathy.
Nutr Clin Pract. 2010 Jun; 25(3):257-64.NC

Abstract

Protein calorie malnutrition (PCM) is a well-known complication of chronic liver disease (CLD). A major contribution to PCM in CLD is restriction of dietary protein intake. After many decades of injudicious reduction in dietary protein, cirrhotic patients are now prescribed appropriate amounts of protein. PCM in CLD is known to be associated with life-threatening complications. In the general approach to these patients, the initial and most important step for the clinician is to recognize the extent of malnutrition. Most patients tolerate a normal amount of dietary protein without developing hepatic encephalopathy (HE). Oral branched-chain amino acids (BCAAs) have a limited role in HE. Patients who exhibit dietary protein intolerance originally were thought to be best treated with BCAA formulations. Mixed evidence has been reported in multiple studies. In keeping with other reports, this article shows that in animal protein-intolerant patients, even those with advanced cirrhosis, vegetable protein-based diets are well tolerated. Another approach to management of apparent dietary intolerance is to optimize HE treatment with available medications. This article reviews the causes of HE, minimal HE, and PCM; examines nutrition requirements and assessment; and discusses treatment options for malnutrition in HE.

Authors+Show Affiliations

Division of Gastroenterology, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

20581319

Citation

Chadalavada, Rajagopal, et al. "Nutrition in Hepatic Encephalopathy." Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, vol. 25, no. 3, 2010, pp. 257-64.
Chadalavada R, Sappati Biyyani RS, Maxwell J, et al. Nutrition in hepatic encephalopathy. Nutr Clin Pract. 2010;25(3):257-64.
Chadalavada, R., Sappati Biyyani, R. S., Maxwell, J., & Mullen, K. (2010). Nutrition in hepatic encephalopathy. Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, 25(3), 257-64. https://doi.org/10.1177/0884533610368712
Chadalavada R, et al. Nutrition in Hepatic Encephalopathy. Nutr Clin Pract. 2010;25(3):257-64. PubMed PMID: 20581319.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nutrition in hepatic encephalopathy. AU - Chadalavada,Rajagopal, AU - Sappati Biyyani,Raja Shekhar, AU - Maxwell,John, AU - Mullen,Kevin, PY - 2010/6/29/entrez PY - 2010/6/29/pubmed PY - 2010/12/16/medline SP - 257 EP - 64 JF - Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition JO - Nutr Clin Pract VL - 25 IS - 3 N2 - Protein calorie malnutrition (PCM) is a well-known complication of chronic liver disease (CLD). A major contribution to PCM in CLD is restriction of dietary protein intake. After many decades of injudicious reduction in dietary protein, cirrhotic patients are now prescribed appropriate amounts of protein. PCM in CLD is known to be associated with life-threatening complications. In the general approach to these patients, the initial and most important step for the clinician is to recognize the extent of malnutrition. Most patients tolerate a normal amount of dietary protein without developing hepatic encephalopathy (HE). Oral branched-chain amino acids (BCAAs) have a limited role in HE. Patients who exhibit dietary protein intolerance originally were thought to be best treated with BCAA formulations. Mixed evidence has been reported in multiple studies. In keeping with other reports, this article shows that in animal protein-intolerant patients, even those with advanced cirrhosis, vegetable protein-based diets are well tolerated. Another approach to management of apparent dietary intolerance is to optimize HE treatment with available medications. This article reviews the causes of HE, minimal HE, and PCM; examines nutrition requirements and assessment; and discusses treatment options for malnutrition in HE. SN - 1941-2452 UR - https://www.unboundmedicine.com/medline/citation/20581319/Nutrition_in_hepatic_encephalopathy_ L2 - https://doi.org/10.1177/0884533610368712 DB - PRIME DP - Unbound Medicine ER -