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Low-protein diets for hepatic encephalopathy debunked: let them eat steak.
Nutr Clin Pract 2011; 26(2):155-9NC

Abstract

Hepatic encephalopathy (HE) is an incompletely understood phenomenon and serves as a poor prognosis in patients with cirrhosis. Confusion from HE can affect the ability to eat adequately. Despite the prevalence of malnutrition in cirrhotic patients in the 1950s, it was reported that bouts of overt HE were controlled with low protein intake. This largely uncontrolled observation led to restriction of protein intake in cirrhotic patients with or without HE and was an accepted standard of care for many decades to follow. Published in 2004, the pivotal article "Normal Protein Diet for Episodic Hepatic Encephalopathy: Results of a Randomized Study" by Cordoba and colleagues was the first controlled study randomizing cirrhotic patients with HE to receive different amounts of dietary protein. At the completion of the study, the authors concluded that a normal-protein diet was safe and did not exacerbate HE. The Cordoba study suggests that low-protein diets should be abandoned. In light of this evidence, nutrition guidelines have proposed that protein restriction should be avoided in patients with HE as protein requirements are increased in cirrhosis. Despite the advice of experts in the field, it has been shown in recent years that some physicians still believe that protein restriction is needed in patients with HE. This belief has not been substantiated in controlled studies, and societal recommendations have changed. There is no real evidence documenting the advantages of protein restriction in HE. On the contrary, Cordoba and colleagues' article has shown that there are disadvantages to restricting protein in HE.

Authors+Show Affiliations

Gastroenterology, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA. Chad.M.Cabral@Lahey.orgNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21447768

Citation

Cabral, Chad Michael, and David L. Burns. "Low-protein Diets for Hepatic Encephalopathy Debunked: Let Them Eat Steak." Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, vol. 26, no. 2, 2011, pp. 155-9.
Cabral CM, Burns DL. Low-protein diets for hepatic encephalopathy debunked: let them eat steak. Nutr Clin Pract. 2011;26(2):155-9.
Cabral, C. M., & Burns, D. L. (2011). Low-protein diets for hepatic encephalopathy debunked: let them eat steak. Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition, 26(2), pp. 155-9. doi:10.1177/0884533611400086.
Cabral CM, Burns DL. Low-protein Diets for Hepatic Encephalopathy Debunked: Let Them Eat Steak. Nutr Clin Pract. 2011;26(2):155-9. PubMed PMID: 21447768.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Low-protein diets for hepatic encephalopathy debunked: let them eat steak. AU - Cabral,Chad Michael, AU - Burns,David L, PY - 2011/3/31/entrez PY - 2011/3/31/pubmed PY - 2011/5/24/medline SP - 155 EP - 9 JF - Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition JO - Nutr Clin Pract VL - 26 IS - 2 N2 - Hepatic encephalopathy (HE) is an incompletely understood phenomenon and serves as a poor prognosis in patients with cirrhosis. Confusion from HE can affect the ability to eat adequately. Despite the prevalence of malnutrition in cirrhotic patients in the 1950s, it was reported that bouts of overt HE were controlled with low protein intake. This largely uncontrolled observation led to restriction of protein intake in cirrhotic patients with or without HE and was an accepted standard of care for many decades to follow. Published in 2004, the pivotal article "Normal Protein Diet for Episodic Hepatic Encephalopathy: Results of a Randomized Study" by Cordoba and colleagues was the first controlled study randomizing cirrhotic patients with HE to receive different amounts of dietary protein. At the completion of the study, the authors concluded that a normal-protein diet was safe and did not exacerbate HE. The Cordoba study suggests that low-protein diets should be abandoned. In light of this evidence, nutrition guidelines have proposed that protein restriction should be avoided in patients with HE as protein requirements are increased in cirrhosis. Despite the advice of experts in the field, it has been shown in recent years that some physicians still believe that protein restriction is needed in patients with HE. This belief has not been substantiated in controlled studies, and societal recommendations have changed. There is no real evidence documenting the advantages of protein restriction in HE. On the contrary, Cordoba and colleagues' article has shown that there are disadvantages to restricting protein in HE. SN - 1941-2452 UR - https://www.unboundmedicine.com/medline/citation/21447768/Low_protein_diets_for_hepatic_encephalopathy_debunked:_let_them_eat_steak_ L2 - https://doi.org/10.1177/0884533611400086 DB - PRIME DP - Unbound Medicine ER -