Dietary Interventions in Liver Cirrhosis

Abstract

Liver cirrhosis is associated with significant nutritional risks that often result in serious hepatic complications and poor survival rates. Diet is an important but underutilized aspect in the treatment modality of cirrhosis. Therefore, the aims of this review are to ascertain nutritional risks associated with its pathophysiology and to summarize existing evidence that support dietary recommendations for managing this patient population. Alterations in substrate utilization for energy production is a main feature of liver cirrhosis, resulting in increased catabolism of protein stores and a predisposition toward protein-energy malnutrition, even in the early stages of the disease. The body of evidence suggests that a high energy and protein (>1.2 g/kg body weight/d) diet consumed frequently and late in the evening is effective in improving nutritional status of these patients and has been associated with improved hospitalization and mortality rates. The use of branched-chain amino acid supplementation shows promise in reducing cirrhosis-related complications but are currently limited by adverse gastrointestinal symptoms and poor palatability. Furthermore exploration of dietary manipulation of branched-chain amino acid warrants further examination. Evidence is also accumulating that protein intake should not be restricted in patients with hepatic encephalopathy with earlier studies of protein restriction neglecting to account for the relative increase in fermentable fiber which would reduce the absorption of ammonia into the portal system in a way similar to supplementation with lactulose. Finally, a major finding of this review is the need to improve the quality and quantity of dietary intervention studies for patients with liver cirrhosis, particularly with the use of partial or whole dietary sources. In conclusion, dietary management of cirrhosis is not a one-size fits all approach but should be implemented earlier on in the treatment algorithm to improve the clinical prognosis of cirrhosis.

ACVIM consensus statement on the diagnosis and treatment of chronic hepatitis in dogs

“…No studies have investigated dietary protein requirements in dogs with CH. Based on studies in humans, protein restriction is not recommended for most dogs with CH . If signs of HE are suspected, feeding a prescription diet with protein restricted to 2.1‐2.5 g protein/kg body weight (when consumed for maintenance energy requirements) can be a starting point.…”

“…Based on studies in humans, protein restriction is not recommended for most dogs with CH. 335,336 If signs of HE are suspected, feeding a prescription diet with protein restricted to 2.…”

Royal Free Hospital-Nutritional Prioritizing Tool improves the prediction of malnutrition risk outcomes in liver cirrhosis patients compared with Nutritional Risk Screening 2002

“…It is not only associated with the progression of liver dysfunction (5) but is also related to complications of liver cirrhosis, such as infections, hepatic encephalopathy and ascites (6,7) . Early nutritional intervention is essential to reduce the length of hospital stay and healthcare-associated costs, improve quality of life and decrease the mortality rate (8,9) . However, nutritional intervention is usually delayed owing to the failure to assess the risk of malnutrition and the differences in the accuracy of screening tools (10) .…”

Dietary approach and gut microbiota modulation for chronic hepatic encephalopathy in cirrhosis

“…Another advantage of vegetable proteins is their high fiber content[145], which favors intestinal transit and consequently a more efficient ammonia excretion. Moreover, fiber digestion operated by intestinal bacteria produces the SCFAs acetic, propionic, and butyric acid, therefore reducing colonic pH, which improves ammonia excretion[161,162]. This may result in favorable changes in microbiota composition, with associated enhanced anti-inflammatory and antioxidant properties[163,164].…”