Controlled Trial on Nutrition Supplementation in Outpatients With Symptomatic Alcoholic Cirrhosis

Hirsch, Sandra; Bunout, Daniel; Maza, Pia de la; Iturriaga, H; Petermann, Marcus; Icazar, Gloria; Gattás, Vivien; Ugarte, G

doi:10.1177/0148607193017002119

Cited by 153 publications

(92 citation statements)

References 33 publications

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“…Following ONS, weight gain varied considerably and depended on the duration and amount of supplementation, and the disease status of patients. Mean percentage weight change in supplemented patients compared with unsupplemented control patients could be calculated in twenty-two randomized controlled studies of adults (duration of ONS 10 d-1 year, n 900 patients; Douglass et al 1978;Foster et al 1980;Elkort et al 1981;Simko, 1983;Lewis et al 1987;Norregaard et al 1987;Efthimiou et al 1988;Knowles et al 1988;Arnold & Richter, 1989;Donahoe et al 1989;Otte et al 1989;Fuenzalida et al 1990;Nayel et al 1992;Rogers et al 1992;Hirsch et al 1993;Fiatarone et al 1994;Woo et al 1994;Gray-Donald et al 1995;Volkert et al 1996;Jensen & Hessov, 1997;Keele et al 1997;Rabeneck et al 1998). The mean percentage weight change of patients receiving ONS (2·93 %) was greater than that of the unsupplemented control patients (1·15 %, mean difference 1·77, range −2·69 to 9·2 %; weighted for the number of subjects in each category).…”

Section: Outcome Measuresmentioning

confidence: 99%

Summary of a systematic review on oral nutritional supplement use in the community

Stratton

2000

Proc. Nutr. Soc.

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Despite a marked increase in the prescription of oral nutritional supplements (ONS) in the community (Department of Health, 1991–7), there is still uncertainty about the value of their use in patients with different diseases. To answer questions about the effects on ONS on body weight and structure, spontaneous food intake and body function, a critical systematic review was undertaken (Stratton & Elia, 1999a). Eighty-four trials were reviewed (forty-five randomized, thirty-nine non-randomized; 2570 patients; diagnoses including chronic obstructive pulmonary disease, Crohn’s disease, cystic fibrosis, human immunodeficiency virus and acquired immune deficiency syndrome and cancer). Most studies (83 %) were conducted in patients living at home. The supplements were typically mixed macronutrients in liquid form, providing < 0.42–10.5 MJ/d for 1 week–2 years. The studies reviewed in patients with predominantly chronic conditions living in the community suggested that: (1) ONS produce demonstrable clinical (including functional) benefits, but the nature and extent of these benefits varies with the underlying chronic condition; (2) ONS increase total energy intake with > 50 % of the energy from ONS typically additional to that from habitual food intake; (3) improvements in body weight, total energy intake and body function following ONS appear to occur more frequently in individuals with a BMI < 20 kg/m2 than in those with a BMI > 20 kg/m2.

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Section: Outcome Measuresmentioning

confidence: 99%

Summary of a systematic review on oral nutritional supplement use in the community

Stratton

2000

Proc. Nutr. Soc.

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“…BCAA significantly improved encephalopathy, nitrogen balance, and serum bilirubin compared with casein. Hirsch et al (115) supplemented 34 g of protein and 1000 kilocalories to a regular diet in decompensated alcoholic cirrhotics and reduced hospitalizations for infections. These studies are important because they emphasize the concept that patient selection and long term therapy (116) may be important factors for employing and demonstrating the benefits of nutritional therapy.…”

Section: Nutritional Therapymentioning

confidence: 99%

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

McCullough

1998

The American Journal of Gastroenterology

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PREAMBLEGuidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When data are not available that will withstand objective scrutiny, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. Given the wide range of choices in any health care problem, the physician should select the course best suited to the individual patient and the clinical situation presented.These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. These guidelines are also approved by the governing boards of the American Gastroenterological Association and the American Association for the Study of Liver Disease. Expert opinion is solicited from the outset for the document. Guidelines are reviewed in depth by the Committee, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time.Objective: The objective of this work was to develop practice guidelines for the management of alcoholic liver disease. Method: A computerized search using the Medline Data Base from 1966 -July 1997 was performed with the search headings; alcohol, alcoholic hepatitis, alcoholic liver disease, liver transplant, diagnosis, epidemiology, human, and English only. All randomized controlled trials, case-control studies, and meta-analyses were read in depth. A manual search was also done using references from each retrieved report, review articles, editorials, postgraduate course syllabi, and textbooks. In the subsequent review, evidence was evaluated using a hierarchical scale with randomized, controlled trials given the most importance. Abstracts presented at national meetings were included only when unique data were obtained from those studies. (Am J Gastroenterol 1998;93:2022-2036.

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“…Infection rates were signi®cantly improved by the ENS in one of the trials, 99 but not in two others. 97,98 There were no other differences with regard to other forms of morbidity.…”

Section: Liver Diseasementioning

confidence: 86%

“…96±99 Similarly, there was no apparent impact of the ENS on the overall duration of hospitalization, 96,99 although, in the one long-term trial, the recipients of the ENS had fewer total admissions. A number of PRCTs have addressed the utility of BCAAs in liver disease, in particular with regard to the treatment of hepatic encephalopathy.…”

Section: Liver Diseasementioning

confidence: 99%

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Nutritional support

Ofman

Koretz

1997

Aliment Pharmacol Ther

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Nutritional support currently accounts for about 1% of the total health care costs in the USA. Interestingly, most of the prospective randomized controlled trials to date have not been able to demonstrate that this therapeutic intervention alters morbidity or mortality. In fact, parenteral nutritional support may predispose the recipients to developing systemic infections. There have been a few areas in which nutritional support may be of benefit. Enteral supplements given to underweight women who suffer hip fractures reduce the hospital stay and, presumably, overall cost. Preoper‐ative parenteral nutritional support may produce a small absolute reduction in post‐operative morbidity, but its cost becomes prohibitive. Preoperative enteral nutritional support, especially if carried out in the home, may be of benefit (using the most optimistic interpretation of a small number of trials); if so, it is an economically defensible intervention. Particular nutrients or diets may have specific effects on certain disease processes. Indirect comparisons have suggested that elemental diets can be used to treat flares of Crohn's disease (perhaps because putative food antigens are removed). However, corticosteroid therapy is more efficacious. Furthermore, it is less expensive to employ 6‐mercaptopurine as the next modality in steroid failures. Branched‐chain amino acid infusions may have some effect on hepatic encephalopathy, but again, lactulose is less expensive. Nutritional support is one area of medicine in which there has been far more enthusiasm than the data justify. Disease‐associated malnutrition probably is a secondary phenomenon, not an important cause of morbidity. The widespread use of this modality cannot be justified in a cost‐constrained health care system.

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Controlled Trial on Nutrition Supplementation in Outpatients With Symptomatic Alcoholic Cirrhosis

Cited by 153 publications

References 33 publications

Summary of a systematic review on oral nutritional supplement use in the community

Summary of a systematic review on oral nutritional supplement use in the community

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

Nutritional support

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