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Meta-analysis: oral or enteral nutritional supplementation in cirrhosis.

Abstract

BACKGROUND

Malnutrition is a common and clinically significant problem in patients with cirrhosis. The impact of nutritional therapy remains unclear.

AIM

To provide an up-to-date systematic review and meta-analysis of RCTs of oral or enteral nutritional supplementation (ONS or ENS) on nutritional and clinical outcomes in adult patients with cirrhosis.

METHODS

The primary outcome measure was survival. Included: full-text English language RCTs investigating ONS or ENS vs. a standard nonsupplemented diet in patients with cirrhosis. Excluded: parenteral or branched chain amino acids intervention; treatment duration ≤7 days, exclusive evaluation of posttransplant, postsurgical or quality of life outcomes.

RESULTS

Six trials (4 ONS/2 ENS) and 470 patients were included with 71% males and median age 53 years. When all studies were combined, there was no reduction in mortality [Relative risk (RR): 0.75 (0.42, 1.32), P = 0.31]. Subgroup analysis of 3 of the 4 ONS studies did demonstrate a mortality reduction [RR: 0.40 (0.18, 0.90), P = 0.03]. Of the 2 ENS studies, one included the sickest patients in the meta-analysis (82% Child Pugh C) and the other had the shortest mean intervention duration (8.6 days), possibly impacting the potential for benefit. Study quality was suboptimal (median Jadad = 2).

CONCLUSIONS

Although there is insufficient evidence to definitively state that oro-enteral nutritional supplementation impacts clinical outcomes, on the basis of this analysis, one can be cautiously optimistic that there is the potential for benefit without an increase in adverse events. Adequately powered, Child Pugh stratified studies of at least 1 month in duration are needed to clarify the impact on relevant clinical outcomes.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, University of Alberta, Edmonton, AB, Canada.

    , , , ,

    Source

    MeSH

    Adult
    Dietary Supplements
    Enteral Nutrition
    Female
    Humans
    Liver Cirrhosis
    Male
    Malnutrition
    Middle Aged
    Randomized Controlled Trials as Topic

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    23421379

    Citation

    Ney, M, et al. "Meta-analysis: Oral or Enteral Nutritional Supplementation in Cirrhosis." Alimentary Pharmacology & Therapeutics, vol. 37, no. 7, 2013, pp. 672-9.
    Ney M, Vandermeer B, van Zanten SJ, et al. Meta-analysis: oral or enteral nutritional supplementation in cirrhosis. Aliment Pharmacol Ther. 2013;37(7):672-9.
    Ney, M., Vandermeer, B., van Zanten, S. J., Ma, M. M., Gramlich, L., & Tandon, P. (2013). Meta-analysis: oral or enteral nutritional supplementation in cirrhosis. Alimentary Pharmacology & Therapeutics, 37(7), pp. 672-9. doi:10.1111/apt.12252.
    Ney M, et al. Meta-analysis: Oral or Enteral Nutritional Supplementation in Cirrhosis. Aliment Pharmacol Ther. 2013;37(7):672-9. PubMed PMID: 23421379.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Meta-analysis: oral or enteral nutritional supplementation in cirrhosis. AU - Ney,M, AU - Vandermeer,B, AU - van Zanten,S J V, AU - Ma,M M, AU - Gramlich,L, AU - Tandon,P, Y1 - 2013/02/20/ PY - 2012/12/01/received PY - 2013/01/03/revised PY - 2013/01/16/revised PY - 2013/01/28/accepted PY - 2013/2/21/entrez PY - 2013/2/21/pubmed PY - 2013/9/6/medline SP - 672 EP - 9 JF - Alimentary pharmacology & therapeutics JO - Aliment. Pharmacol. Ther. VL - 37 IS - 7 N2 - BACKGROUND: Malnutrition is a common and clinically significant problem in patients with cirrhosis. The impact of nutritional therapy remains unclear. AIM: To provide an up-to-date systematic review and meta-analysis of RCTs of oral or enteral nutritional supplementation (ONS or ENS) on nutritional and clinical outcomes in adult patients with cirrhosis. METHODS: The primary outcome measure was survival. Included: full-text English language RCTs investigating ONS or ENS vs. a standard nonsupplemented diet in patients with cirrhosis. Excluded: parenteral or branched chain amino acids intervention; treatment duration ≤7 days, exclusive evaluation of posttransplant, postsurgical or quality of life outcomes. RESULTS: Six trials (4 ONS/2 ENS) and 470 patients were included with 71% males and median age 53 years. When all studies were combined, there was no reduction in mortality [Relative risk (RR): 0.75 (0.42, 1.32), P = 0.31]. Subgroup analysis of 3 of the 4 ONS studies did demonstrate a mortality reduction [RR: 0.40 (0.18, 0.90), P = 0.03]. Of the 2 ENS studies, one included the sickest patients in the meta-analysis (82% Child Pugh C) and the other had the shortest mean intervention duration (8.6 days), possibly impacting the potential for benefit. Study quality was suboptimal (median Jadad = 2). CONCLUSIONS: Although there is insufficient evidence to definitively state that oro-enteral nutritional supplementation impacts clinical outcomes, on the basis of this analysis, one can be cautiously optimistic that there is the potential for benefit without an increase in adverse events. Adequately powered, Child Pugh stratified studies of at least 1 month in duration are needed to clarify the impact on relevant clinical outcomes. SN - 1365-2036 UR - https://www.unboundmedicine.com/medline/citation/23421379/full_citation L2 - https://doi.org/10.1111/apt.12252 DB - PRIME DP - Unbound Medicine ER -