Diets in Encephalopathy

Abdelsayed, George

doi:10.1016/j.cld.2015.05.001

Cited by 8 publications

(5 citation statements)

References 37 publications

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“…Restriction in amount of protein intake should only be advised based on expert review as this can lead to muscle wasting . Nutritional intervention is necessary for patients intolerant to the first line of treatment drugs or patients treated for couple of months with no improvement . Muscle tissue plays an important role in converting ammonia to glutamine, thereby reducing blood ammonia level; therefore, proper care should be taken to prevent malnutrition as this greatly affects the prognosis .…”

Section: Treatment Of Hepatic Encephalopathymentioning

confidence: 99%

Mechanistic insight, diagnosis, and treatment of ammonia‐induced hepatic encephalopathy

Kenston

Song

Zhou

et al. 2018

J of Gastro and Hepatol

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Hepatic encephalopathy is a neuropsychological syndrome due to biochemical disturbance of brain function in advanced liver disease patients. Diagnosis and treatment of the condition is very demanding and has negative toll on finances with increased healthcare utilization. The pathophysiology is not completely understood; however, there is evidence that ammonia plays an important role in the etiology. Conventional methods of solely relying on blood ammonia level to diagnose hepatic encephalopathy did not help much; likewise, the use of lactulose alone in treating hepatic encephalopathy has also been discouraged. This paper analyzed the current knowledge regarding the mechanism of how ammonia disrupts the normal brain function as well as the use of latest diagnosing tools including those under development to evaluate the neuropsychiatric state of patients and their quality of life. The efficacies of lactulose and rifaximin combination for short-term and long-term treatment in addition to nutritional interventions and other drugs undergoing clinical trials were also reviewed.

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Section: Treatment Of Hepatic Encephalopathymentioning

confidence: 99%

Mechanistic insight, diagnosis, and treatment of ammonia‐induced hepatic encephalopathy

Kenston

Song

Zhou

et al. 2018

J of Gastro and Hepatol

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“…Other alterations: additional metabolic alterations observed in these patients include alteration in appetite-regulating hormones and, in patients with cholestasis, reduction in the pool of bile salts resulting in malabsorption of fats and fat-soluble vitamins [ 13 ].…”

Section: Metabolic Alterations In Liver Cirrhosismentioning

confidence: 99%

“…The reasons why diet rich in vegetable protein and low in animal protein results in improved HE is not clearly known. There are a few possibilities: The lower ratio of sulphur amino acids, such as methionine and cysteine, to BCAAs [ 59 ]; The reduced formation of mercaptans from sulphur amino acids fermentation, which appear to be involved in the genesis of HE along with ammonium [ 13 ]; The significant increase in fermentable fibre. In fact, levels of protein fermentation end products, such as ammonium and phenols, are significantly reduced when dietary fibre intake is increased.…”

Section: Optimization Of Nutritional Statusmentioning

confidence: 99%

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Nutrition Assessment and Management in Patients with Cirrhosis and Cognitive Impairment: A Comprehensive Review of Literature

Faccioli¹,

Nardelli²,

Gioia³

et al. 2022

JCM

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Hepatic encephalopathy (HE) represents a common complication of liver cirrhosis. Protein-calorie malnutrition is frequently encountered in the cirrhotic patient and its most obvious clinical manifestation is sarcopenia. This condition represents a risk factor for HE occurrence because skeletal muscle acts as an alternative site for ammonium detoxification. Preventive intervention through an adequate assessment of nutritional status should be carried out at early stages of the disease and in a multidisciplinary team using both non-instrumental methods (food diary, anthropometric measurements, blood chemistry tests) and instrumental methods (bioimpedance testing, DEXA, CT, indirect calorimetry, dynamometry). Dietary recommendations for patients with HE do not differ from those for cirrhotic patient without HE. Daily caloric intake in the non-obese patient should be 30–40 Kcal/Kg/day with a protein intake of 1–1.5 g/Kg/day, especially of vegetable origin, through 4–6 meals daily. In patients with HE, it is also essential to monitor electrolyte balance, supplementing any micronutrient deficiencies such as sodium and zinc, as well as vitamin deficiencies because they can cause neurological symptoms similar to those of HE. In light of the critical role of nutritional status, this aspect should not be underestimated and should be included in the diagnostic–therapeutic algorithm of patients with HE.

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“…Hepatic enteral formulas are characterized by a very low‐protein, concentrated product that contains a significant amount of branched‐chain amino acids (BCAAs) and reduced aromatic amino acids (AAAs). In cirrhotic patients, BCAAs (leucine, isoleucine, and valine) in the skeletal muscle are used for the production of glutamine as an energy source; this process reduces BCAA levels 56 . Also, cirrhotic patients are unable to metabolize AAA (trypotophan, tyrosine, and phenylalanine) well, so AAA levels increase.…”

Section: Disease‐specific Formulasmentioning

confidence: 99%

Enteral Formulas in Nutrition Support Practice

Escuro

Hummell

2016

Nut in Clin Prac

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Over the past few decades, the number of enteral formulas for use in hospitalized, critically ill, and home enteral patients has dramatically increased. Several enteral nutrition (EN) formula categories exist, which makes it challenging for clinicians to sort through the product claims and find the appropriate formula for the patient. Many formulas are available within each category, some of which may be significantly different from one another. Numerous systematic reviews of existing research and clinical practice guidelines evaluate the use of specialty formulas. This review aims to examine the differences in various enteral formula categories, identify applications in clinical practice, and evaluate the existing evidence and guideline recommendations for use of specific types of enteral formulas.

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Diets in Encephalopathy

Cited by 8 publications

References 37 publications

Mechanistic insight, diagnosis, and treatment of ammonia‐induced hepatic encephalopathy

Mechanistic insight, diagnosis, and treatment of ammonia‐induced hepatic encephalopathy

Nutrition Assessment and Management in Patients with Cirrhosis and Cognitive Impairment: A Comprehensive Review of Literature

Enteral Formulas in Nutrition Support Practice

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