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A systematic review and meta-analysis of the use of oral zinc in the treatment of hepatic encephalopathy.

Abstract

BACKGROUND AND AIM

Because low serum zinc levels precipitate hepatic encephalopathy, zinc supplementation is considered a potential therapeutic option. The aim of this study was to assess the effects of oral zinc supplementation in the treatment of hepatic encephalopathy.

METHODS

For this systematic review and meta-analysis, data sources included electronic databases (CENTRAL, MEDLINE, EMBASE) and manual searching. Randomized clinical trials of adult patients diagnosed with liver cirrhosis and hepatic encephalopathy were included. The types of interventions considered were any oral zinc supplementation versus no intervention, placebo, or other interventions for the management of hepatic encephalopathy. The data were analyzed by calculating the RR for each trial and expressing the uncertainty as 95% CI. Continuous data were analyzed by calculating the standard mean differences (SMD) between groups within each trial and their 95% CI. Statistical heterogeneity was defined as a P-value > 0.10 (χ2) or I2 > 25%.

RESULTS

Four trials with a total of 233 patients were included. Oral zinc supplementation was associated with a significant improvement in performance on the number connection test (SMD -0.62; 95% CI -1.12 to -0.11) reported in three trials (n = 189), but not with encephalopathy recurrence reduction (RR 0.64; 95% CI 0.26 to 1.59) reported in two trials (n = 169). Other clinically significant outcomes (mortality, liver related morbidity, quality of life) were not reported.

CONCLUSION

Oral zinc supplementation improved performance on the number connection test, but no evidence about other clinical or biochemical outcomes was available.

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  • Authors+Show Affiliations

    ,

    Obesity and Digestive Diseases Unit, Medica Sur Clinic & Foundation, Mexico City, Mexico. khavez@gmail.com

    , , , ,

    Source

    Nutrition journal 12: 2013 Jun 06 pg 74

    MeSH

    Administration, Oral
    Evidence-Based Medicine
    Hepatic Encephalopathy
    Humans
    Randomized Controlled Trials as Topic
    Treatment Outcome
    Zinc

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    23742732

    Citation

    Chavez-Tapia, Norberto C., et al. "A Systematic Review and Meta-analysis of the Use of Oral Zinc in the Treatment of Hepatic Encephalopathy." Nutrition Journal, vol. 12, 2013, p. 74.
    Chavez-Tapia NC, Cesar-Arce A, Barrientos-Gutiérrez T, et al. A systematic review and meta-analysis of the use of oral zinc in the treatment of hepatic encephalopathy. Nutr J. 2013;12:74.
    Chavez-Tapia, N. C., Cesar-Arce, A., Barrientos-Gutiérrez, T., Villegas-López, F. A., Méndez-Sanchez, N., & Uribe, M. (2013). A systematic review and meta-analysis of the use of oral zinc in the treatment of hepatic encephalopathy. Nutrition Journal, 12, p. 74. doi:10.1186/1475-2891-12-74.
    Chavez-Tapia NC, et al. A Systematic Review and Meta-analysis of the Use of Oral Zinc in the Treatment of Hepatic Encephalopathy. Nutr J. 2013 Jun 6;12:74. PubMed PMID: 23742732.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - A systematic review and meta-analysis of the use of oral zinc in the treatment of hepatic encephalopathy. AU - Chavez-Tapia,Norberto C, AU - Cesar-Arce,Asunción, AU - Barrientos-Gutiérrez,Tonatiuh, AU - Villegas-López,Francisco A, AU - Méndez-Sanchez,Nahum, AU - Uribe,Misael, Y1 - 2013/06/06/ PY - 2012/10/29/received PY - 2013/06/04/accepted PY - 2013/6/8/entrez PY - 2013/6/8/pubmed PY - 2014/1/17/medline SP - 74 EP - 74 JF - Nutrition journal JO - Nutr J VL - 12 N2 - BACKGROUND AND AIM: Because low serum zinc levels precipitate hepatic encephalopathy, zinc supplementation is considered a potential therapeutic option. The aim of this study was to assess the effects of oral zinc supplementation in the treatment of hepatic encephalopathy. METHODS: For this systematic review and meta-analysis, data sources included electronic databases (CENTRAL, MEDLINE, EMBASE) and manual searching. Randomized clinical trials of adult patients diagnosed with liver cirrhosis and hepatic encephalopathy were included. The types of interventions considered were any oral zinc supplementation versus no intervention, placebo, or other interventions for the management of hepatic encephalopathy. The data were analyzed by calculating the RR for each trial and expressing the uncertainty as 95% CI. Continuous data were analyzed by calculating the standard mean differences (SMD) between groups within each trial and their 95% CI. Statistical heterogeneity was defined as a P-value > 0.10 (χ2) or I2 > 25%. RESULTS: Four trials with a total of 233 patients were included. Oral zinc supplementation was associated with a significant improvement in performance on the number connection test (SMD -0.62; 95% CI -1.12 to -0.11) reported in three trials (n = 189), but not with encephalopathy recurrence reduction (RR 0.64; 95% CI 0.26 to 1.59) reported in two trials (n = 169). Other clinically significant outcomes (mortality, liver related morbidity, quality of life) were not reported. CONCLUSION: Oral zinc supplementation improved performance on the number connection test, but no evidence about other clinical or biochemical outcomes was available. SN - 1475-2891 UR - https://www.unboundmedicine.com/medline/citation/23742732/full_citation L2 - https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-12-74 DB - PRIME DP - Unbound Medicine ER -