Effects of Late Evening Snack on Cirrhotic Patients: A Systematic Review and Meta-Analysis

Abstract

Background Energetic effects of late evening snack (LES) on cirrhotic patients were reported recently, but there was no quantitative analysis. In this meta-analysis, we reviewed and quantified the effects of LES on energy metabolism and substrate oxidation in the patients with cirrhosis, which will be of benefit for liver cirrhosis nutritional therapy. Methods A systematic search was conducted in PubMed, Embase, Web of Science, Elsevier, China National Knowledge Infrastructure, and Wanfang Database for relevant trials published until July 2017. These studies statistically were combined and analyzed by RevMan 5.3. Results Fourteen trials comprising 478 cases were eligible for analysis. The results showed that the respiratory quotient value (MD = 11.09) and carbohydrate oxidation value (MD = 0.05) significantly elevated with one week or with up to three weeks of LES treatment in cirrhotic patients (P < 0.05). Meanwhile, the levels of serum albumin (MD = 2.98) and cholinesterase (SMD = 1.09) were increased with LES administration for three weeks or that lasting twelve weeks (P < 0.05). However, there was no significant improvement for the levels of alanine aminotransferase (ALT) (P = 0.53), aspartate aminotransferase (AST) (P = 0.96), and total bilirubin (TB) (P = 0.32). Conclusions LES could improve the energy malnutrition state of cirrhotic patients. However, it may have little effect on reducing liver parenchymal injury indexes such as serum aminotransferase.

Late Evening Snack with Branched-Chain Amino Acids Supplementation Improves Survival in Patients with Cirrhosis

“…This study is the first to determine the association between LES therapy and improved survival in patients with cirrhosis. A LES has been shown to improve the nutritional status, liver function reserves, and sarcopenia in patients with cirrhosis [8][9][10], each of which raises the potential to improve the survival of these patients; however, little is known about the survival benefit of LES thus far. The novelty of our study is that LES-treated patients demonstrated a significantly higher overall survival than PS-matched patients who did not receive LES therapy.…”

“…Studies investigating the influence of meal patterns on energy metabolism have shown that a late evening snack (LES), which is defined as an oral intake of a branched-chain amino acids (BCAA)-enriched nutrient before bedtime, and more frequent oral intake improve the catabolic state of patients with cirrhosis [8]. A LES has been reported to improve not only the nutritional status but also clinical outcomes, including ascites, HE, and health-related quality of life in patients with cirrhosis [8][9][10]. Therefore, clinical practice guidelines recommend that patients with cirrhosis receive LES therapy to improve their clinical outcomes [1,7,11].…”

Serum Zinc Level and non-Protein Respiratory Quotient in Patients with Chronic Liver Diseases

“…An optimal supply of macro and micronutrients is the mainstay of nutritional therapy in CLD patients. A recent meta-analysis demonstrated the impact of a late evening snack on energy metabolism in LC patients [34].…”

A Systematic Review of Medical Nutrition Therapy Guidelines for Liver Cirrhosis: Do We Agree?

“…Thus, longer postprandial periods are desired in cirrhosis to improve nutrition status, and the consumption of several small meals is a step toward this direction. In addition, based on a recent systematic review, a late‐evening snack can be used as a means to improve malnutrition among cirrhotic patients and ameliorate morning starving state, and this is why some CPGs suggested the consumption of a late‐night snack.…”