Dietary management and supplementation with branched-chain amino acids in cirrhosis of the liver

Ruiz-Margáin, Astrid; Méndez-Guerrero, Osvely; Román-Calleja, B.M.; González-Rodríguez, S.; Fernández-del-Rivero, G.; Rodríguez-Córdova, P.A.; Torre, Aldo; Macías-Rodríguez, Ricardo Ulises

doi:10.1016/j.rgmxen.2018.10.004

Cited by 4 publications

(5 citation statements)

References 40 publications

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“…Furthermore, protein supplementation was a good source to increase the protein intake of patients till discharge from hospital. The daily calories intake of patients was also improved by suggesting multiple snacks, adequate food servings, food from all food groups and supplementation (25) . The use of oral dietary supplements can be a good option in liver cirrhosis patients; as suggested by a Japanese study that investigated the effect of regular snacks enriched with branched chain amino acids (BCAA) on cirrhosis patients for the duration of 3 months and it found there was an improvement in the serum albumin levels and other parameters of the patients who were consuming evening snacks with BCAA.…”

Section: Discussionmentioning

confidence: 99%

Evaluating the Impact of Early Nutritional Assessment and Intervention in Hospitalized Liver Cirrhosis Patients

Javaid

Khan

ALI

et al. 2022

Arq. Gastroenterol.

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Background Malnutrition is common in liver cirrhosis patients that is correlated with early complications, morbidity and mortality. Objective The purpose of the study was to assess nutritional status, impact of nutritional screening and intervention in liver cirrhosis patients by evaluating their actual energy and protein intake during hospital stay. Methods A cross sectional study was conducted wherein all patients’ nutritional status was defined by Subjective Global Assessment tool. Adequate energy and protein supply were planned and executed by using individualized nutritional plan for patients with dietitian’s collaboration. Anthropometric measurements included height, weight, body mass index, mid upper arm circumference, hand grip strength and triceps skin-fold thickness. Biochemical tests included haemoglobin, mean corpuscular haemoglobin, volume and concentration, albumin and liver function tests. To record the daily food intake, a 24-hour dietary recall was used. Results Overall 83 patients (mean age 55) were included, among them 46% of patients were moderately malnourished, 12% were normal, while 42% of cirrhotic patients were severely depleted according to Subjective Global Assessment. The mean intake of calories and protein was improved during stay in hospital after nutritional intervention and critical monitoring (P<0.05). Anthropometric measurements at baseline and discharge showed significant differences (P <0.05) in weight, body mass index, triceps skin fold thickness and mid upper arm circumference values, but not in hand grip strength that was associated with malnourishment among patients. Conclusion Providing individualized nutritional intervention and its monitoring by qualified dietitians during hospital stay helps to improve intake in patients that prevent further risk of malnutrition and related complications.

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Section: Discussionmentioning

confidence: 99%

Evaluating the Impact of Early Nutritional Assessment and Intervention in Hospitalized Liver Cirrhosis Patients

Javaid

Khan

ALI

et al. 2022

Arq. Gastroenterol.

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“…It is estimated that carbohydrates should contribute 45%-60% of the total daily energy expenditure, and complex carbohydrates must be included to get > 30 g of fiber. Once the protein and carbohydrate intake has been established, the rest of the total energy expenditure must be covered by lipids, paying special attention to meeting the needs for polyunsaturated fatty acids[ 48 , 49 ].…”

Section: Nutritional Therapymentioning

confidence: 99%

Nutritional therapy for hepatocellular carcinoma

Ruiz-Margáin¹,

Román-Calleja²,

Moreno-Guillén³

et al. 2021

WJGO

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Hepatocellular carcinoma (HCC) is the most frequent primary liver cancer and presents together with cirrhosis in most cases. In addition to commonly recognized risk factors for HCC development, such as hepatitis B virus/hepatitis C virus infection, age and alcohol/tobacco consumption, there are nutritional risk factors also related to HCC development including high intake of saturated fats derived from red meat, type of cooking (generation of heterocyclic amines) and contamination of foods with aflatoxins. On the contrary, protective nutritional factors include diets rich in fiber, fruits and vegetables, n-3 polyunsaturated fatty acids and coffee. While the patient is being evaluated for staging and treatment of HCC, special attention should be paid to nutritional support, including proper nutritional assessment and therapy by a multidisciplinary team. It must be considered that these patients usually develop HCC on top of long-lasting cirrhosis, and therefore they could present with severe malnutrition. Cirrhosis-related complications should be properly addressed and considered for nutritional care. In addition to traditional methods, functional testing, phase angle and computed tomography scan derived skeletal muscle index-L3 are among the most useful tools for nutritional assessment. Nutritional therapy should be centered on providing enough energy and protein to manage the increased requirements of both cirrhosis and cancer. Supplementation with branched-chain amino acids is also recommended as it improves response to treatment, nutritional status and survival, and finally physical exercise must be encouraged and adapted to individual needs.

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“…To provide adequate nutrients balanced oral diet is highly recommended. In liver cirrhosis, the patient's ratio of aromatic amino acid and branched-chain amino acids is disturbed due to hyper metabolism, altered liver function, and decrease dietary intake (32) . Oral supplementation in patients with malnutrition or borderline nutritional status is a better option to avoid further deterioration.…”

Section: Nutritional Managementmentioning

confidence: 99%

“…For this purpose, adequate energy and protein intake should be prioritized. Energy expenditure can be calculated by using formulas or directly according to ESPEN (European Society for Clinical Nutrition and Metabolism) guidelines (32) . Sources of protein should be introduced precisely to the patients according to the condition of patients.…”

Section: Nutritional Managementmentioning

confidence: 99%

Nutritional Management of Liver Cirrhosis and Its Complications in Hospitalized Patients

Javaid

Iqbal

Hameeda

2021

Arq. Gastroenterol.

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BACKGROUND: Cirrhosis is a chronic and progressive liver disease that occurs from prolonged hepatocellular injury. Malnutrition causes complications in cirrhosis patients that worsen the condition to liver failure. Both are closely linked and increase the chances of morbidity and mortality. Regular nutritional screening and monitoring is prime concern for such patients including comprehensive dietary history, laboratory tests, and evaluation of muscle loss and strength capabilities to determine the degree of frailty. For efficient assessment of liver cirrhosis patients Subjective Global Assessment has been used worldwide. The nutritional objectives for such individuals should be to regain liver functions, to prevent complications associated, and to overcome nutritional deficiencies causing malnutrition. METHODS: We conducted a literature review using PubMed, Google Scholar and Science Direct for this purpose, a total of 130 articles were reviewed out of which 80 (from the past 5 years) including originally published research, review articles and abstracts were also included. Exclusion criteria of the selected studies was year of publication, irrelevancy and animal studies based on the purpose of current study. The aim of this study was to check nutritional management in patients having complications of liver cirrhosis. RESULTS: According to the guidelines, for the conservation of normal nutritional status of the malnourished patients’, energy should be provided 35 kcal/kg/day while to prevent hypoalbuminemia and maintain the protein stores in the body, 1.5 g/kg/day protein has been recommended. Carbohydrates and fats for cirrhosis patients are recommended 50% to 60% and 10% to 20% of the total dietary intake respectively. CONCLUSION: Initial identification and prevention of malnutrition have the probability to lead to better health outcomes, prevention of complications of the disease, and improving quality of life.

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Dietary management and supplementation with branched-chain amino acids in cirrhosis of the liver

Cited by 4 publications

References 40 publications

Evaluating the Impact of Early Nutritional Assessment and Intervention in Hospitalized Liver Cirrhosis Patients

Evaluating the Impact of Early Nutritional Assessment and Intervention in Hospitalized Liver Cirrhosis Patients

Nutritional therapy for hepatocellular carcinoma

Nutritional Management of Liver Cirrhosis and Its Complications in Hospitalized Patients

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