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Protein restriction in hepatic encephalopathy is appropriate for selected patients: a point of view.

Abstract

Since the late nineteenth century, protein restriction has been shown to improve hepatic encephalopathy. However, malnutrition has been described in up to 60 % of cirrhotic patients and is associated with increased mortality. Furthermore, emerging clinical evidence has revealed that a large proportion of cirrhotic patients may tolerate normal protein intake. However, approximately one third of cirrhotic patients with hepatic encephalopathy may need a short course of protein restriction, in addition to maximum medical therapy, to ameliorate the clinical course of their hepatic encephalopathy. For patients with chronic hepatic encephalopathy who are protein-sensitive, modifying their sources of nitrogen by using more vegetable protein, less animal protein, and branched-chain amino acids may improve their encephalopathy without further loss of lean body mass. In conclusion, among cirrhotics with hepatic encephalopathy, modulation of normal protein intake must take into account the patient's hepatic reserve, severity of hepatic encephalopathy, and current nutritional status.

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  • Authors+Show Affiliations

    ,

    Gastroenterology Service, VA Long Beach Healthcare System, 11, 5901 E. Seventh Street, Long Beach, CA 90822, USA, Gastroenterology Division, University of California, Irvine, CA, USA.

    Gastroenterology Service, VA Long Beach Healthcare System, 11, 5901 E. Seventh Street, Long Beach, CA 90822, USA, Gastroenterology Division, University of California, Irvine, CA, USA.

    Source

    Hepatology international 8:2 2014 Sep 01 pg 447-51

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    25525477

    Citation

    Nguyen, Douglas L., and Timothy Morgan. "Protein Restriction in Hepatic Encephalopathy Is Appropriate for Selected Patients: a Point of View." Hepatology International, vol. 8, no. 2, 2014, pp. 447-51.
    Nguyen DL, Morgan T. Protein restriction in hepatic encephalopathy is appropriate for selected patients: a point of view. Hepatol Int. 2014;8(2):447-51.
    Nguyen, D. L., & Morgan, T. (2014). Protein restriction in hepatic encephalopathy is appropriate for selected patients: a point of view. Hepatology International, 8(2), pp. 447-51. doi:10.1007/s12072-013-9497-1.
    Nguyen DL, Morgan T. Protein Restriction in Hepatic Encephalopathy Is Appropriate for Selected Patients: a Point of View. Hepatol Int. 2014 Sep 1;8(2):447-51. PubMed PMID: 25525477.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Protein restriction in hepatic encephalopathy is appropriate for selected patients: a point of view. AU - Nguyen,Douglas L, AU - Morgan,Timothy, PY - 2014/12/20/entrez PY - 2014/12/20/pubmed PY - 2014/12/20/medline KW - Hepatic encephalopathy KW - Malnutrition KW - Protein diet SP - 447 EP - 51 JF - Hepatology international JO - Hepatol Int VL - 8 IS - 2 N2 - Since the late nineteenth century, protein restriction has been shown to improve hepatic encephalopathy. However, malnutrition has been described in up to 60 % of cirrhotic patients and is associated with increased mortality. Furthermore, emerging clinical evidence has revealed that a large proportion of cirrhotic patients may tolerate normal protein intake. However, approximately one third of cirrhotic patients with hepatic encephalopathy may need a short course of protein restriction, in addition to maximum medical therapy, to ameliorate the clinical course of their hepatic encephalopathy. For patients with chronic hepatic encephalopathy who are protein-sensitive, modifying their sources of nitrogen by using more vegetable protein, less animal protein, and branched-chain amino acids may improve their encephalopathy without further loss of lean body mass. In conclusion, among cirrhotics with hepatic encephalopathy, modulation of normal protein intake must take into account the patient's hepatic reserve, severity of hepatic encephalopathy, and current nutritional status. SN - 1936-0541 UR - https://www.unboundmedicine.com/medline/citation/25525477/full_citation L2 - https://dx.doi.org/10.1007/s12072-013-9497-1 DB - PRIME DP - Unbound Medicine ER -