Home‐based intensive nutrition therapy improves frailty and sarcopenia in patients with decompensated cirrhosis: A randomized clinical trial

Meena, Babu Lal; Taneja, Sunil; Tandon, Puneeta; Sahni, Neeru; Soundararajan, Raghuraman; Gorsi, Ujjwal; De, Arka; Verma, Nipun; Premkumar, Madhumita; Duseja, Ajay; Dhiman, Radha K.; Singh, Virendra

doi:10.1111/jgh.16035

Cited by 12 publications

(9 citation statements)

References 37 publications

(65 reference statements)

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“…94 Similarly, Meena et al explored the influence of a 6-month dietician-supported home-based intensive nutrition therapy on patients with decompensated cirrhosis. 95 The indicated intervention gave rise to statistically and clinically relevant improvement in frailty determined by the LFI, mirrored as increased body weight, muscle strength, and physical performance.…”

Section: Pre Vention Manag Ement and Tre Atment Of Fr Ailt Ymentioning

confidence: 98%

“…A pilot double‐blind study implicated that BCAAs supplementation alongside physical activity for 12 weeks significantly improve the LFI in entire cohort, wherein some respondents even achieved resolution of baseline frailty 94 . Similarly, Meena et al explored the influence of a 6‐month dietician‐supported home‐based intensive nutrition therapy on patients with decompensated cirrhosis 95 . The indicated intervention gave rise to statistically and clinically relevant improvement in frailty determined by the LFI, mirrored as increased body weight, muscle strength, and physical performance.…”

Section: Prevention Management and Treatment Of Frailtymentioning

confidence: 99%

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Accumulating awareness on the clinical significance and relevance of frailty in cirrhosis: Time to dig deeper into mechanistic basis!

Deng

Hui

Cui

et al. 2023

Liver International

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Given the multifactorial nature and complex pathogenesis in relation to liver cirrhosis, it is justified to stratify progression risk and to prognosticate mortality in terms of various pathological pertubations alongside laboratory markers. In other words, conventional scoring systems, such as the model for end-stage liver disease (MELD) or Child-Turcotte-Pugh (CTP) classification, may fail to capture specific derangements across multiple physiological pillars, which include but not limited to musculoskeletal, endocrine, neurological,

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Section: Pre Vention Manag Ement and Tre Atment Of Fr Ailt Ymentioning

confidence: 98%

Section: Prevention Management and Treatment Of Frailtymentioning

confidence: 99%

Accumulating awareness on the clinical significance and relevance of frailty in cirrhosis: Time to dig deeper into mechanistic basis!

Deng

Hui

Cui

et al. 2023

Liver International

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“…Limited data exist on the impacts of nutritional interventions in sarcopenic patients as it pertains to mortality. A 6-month RCT of home-based intensive nutrition therapy in decompensated cirrhosis patients demonstrated that patients who remained adherent to calorie and protein intake targets within the intervention arm showed superior survival compared to those who did not have nutritional intervention (96.8 vs. 78%, P ¼ 0.04) [46]. ALthough there remains a paucity of literature in the field, the current consensus guidance for patients with end-stage liver disease includes avoiding periods of starvation with bedtime feeding, enteral feeding and parenteral nutrition as well as advising careful exercise [47].…”

Section: Sarcopenia and Prognosismentioning

confidence: 99%

Nutritional deficiencies in alcohol use disorder/alcohol-associated liver disease

Jophlin,

Liu,

McClain

2024

Current Opinion in Gastroenterology

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Purpose of review To delineate common and uncommon dietary and nutritional deficiencies in individuals with chronic heavy alcohol use and alcohol use disorder and to highlight important advances in the nutrition field in patients ranging from those with alcohol use disorder (AUD) and no liver disease to those with decompensated alcohol-associated liver disease (ALD). Recent findings Patients with AUD may have nutritional deficiencies, especially isolated nutrient deficiencies, such as thiamine or zinc deficiencies. This should not be surprising, as alcohol is a major source of “empty calories.” It is devoid of critical macronutrients, such as protein, and micronutrients including important vitamins and minerals. Patients with AUD frequently drink much more than often appreciated (10–20 drinks a day). Patients with AUD and early ALD often begin to develop more apparent nutritional deficiencies. Healthcare providers need to be aware of the presenting features of individual nutrient deficiencies, such as thiamine deficiency, and to provide prompt treatment. In patients with more advanced liver disease, malnutrition correlates with severity of liver disease. It is important to understand the value of nutritional support throughout the spectrum of AUD. Summary We review nutritional deficiencies in the spectrum of patients with AUD and ALD and highlight new information and recommendations.

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“…Moreover, AASLD recommends a safe protein intake of 1.2-1.5 g/kg/d for adults with cirrhosis, which should come from a diverse range of sources[ 7 ]. A recent randomized controlled trial showed that intensive nutrition therapy administered at home for six months can enhance frailty and sarcopenia in patients with decompensated cirrhosis[ 166 ]. The study found that the intervention group showed a greater improvement in the LFI compared to the control group (0.8 vs 0.4; P < 0.001)[ 166 ].…”

Section: Management Of Frailty In Liver Diseasesmentioning

confidence: 99%

“…A recent randomized controlled trial showed that intensive nutrition therapy administered at home for six months can enhance frailty and sarcopenia in patients with decompensated cirrhosis[ 166 ]. The study found that the intervention group showed a greater improvement in the LFI compared to the control group (0.8 vs 0.4; P < 0.001)[ 166 ]. AASLD highlights the importance of identifying and overcoming obstacles to proper nutrition for patients with cirrhosis who are frail[ 7 ].…”

Section: Management Of Frailty In Liver Diseasesmentioning

confidence: 99%

Frailty in end-stage liver disease: Understanding pathophysiology, tools for assessment, and strategies for management

Elsheikh,

Sabagh,

Mohamed

et al. 2023

World J Gastroenterol

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Frailty and sarcopenia are frequently observed in patients with end-stage liver disease. Frailty is a complex condition that arises from deteriorations across various physiological systems, including the musculoskeletal, cardiovascular, and immune systems, resulting in a reduced ability of the body to withstand stressors. This condition is associated with declined resilience and increased vulnerability to negative outcomes, including disability, hospitalization, and mortality. In cirrhotic patients, frailty is influenced by multiple factors, such as hyperammonemia, hormonal imbalance, malnutrition, ascites, hepatic encephalopathy, and alcohol intake. Assessing frailty is crucial in predicting morbidity and mortality in cirrhotic patients. It can aid in making critical decisions regarding patients’ eligibility for critical care and transplantation. This, in turn, can guide the development of an individualized treatment plan for each patient with cirrhosis, with a focus on prioritizing exercise, proper nutrition, and appropriate treatment of hepatic complications as the primary lines of treatment. In this review, we aim to explore the topic of frailty in liver diseases, with a particular emphasis on pathophysiology, clinical assessment, and discuss strategies for preventing frailty through effective treatment of hepatic complications. Furthermore, we explore novel assessment and management strategies that have emerged in recent years, including the use of wearable technology and telemedicine.

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Home‐based intensive nutrition therapy improves frailty and sarcopenia in patients with decompensated cirrhosis: A randomized clinical trial

Cited by 12 publications

References 37 publications

Accumulating awareness on the clinical significance and relevance of frailty in cirrhosis: Time to dig deeper into mechanistic basis!

Accumulating awareness on the clinical significance and relevance of frailty in cirrhosis: Time to dig deeper into mechanistic basis!

Nutritional deficiencies in alcohol use disorder/alcohol-associated liver disease

Frailty in end-stage liver disease: Understanding pathophysiology, tools for assessment, and strategies for management

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