Malnutrition and diabetes mellitus are related to hepatic encephalopathy in patients with liver cirrhosis

Kalaitzakis, Evangelos; Olsson, Rolf; Henfridsson, Pia; Hugosson, Irene; Bengtsson, Mariette; Jalan, Rajiv; Bjõrnsson, Einar

doi:10.1111/j.1478-3231.2007.01562.x

Cited by 100 publications

(88 citation statements)

References 42 publications

(65 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is therefore conceivable that deterioration in nutritional status, rather than nutritional status itself, may be of great importance for cognitive dysfunction in patients with liver cirrhosis. Finally, another factor that may, at least in part, explain the differences between the results of the two studies [4,5] is that we also included patients with minimal HE in our analyses [5] whereas as Soros et al [4] included only patients with clinically overt HE in their study.…”

Section: Introductionmentioning

confidence: 67%

“…Furthermore, in our study, recent weight change was included in the definition of malnutrition [4] whereas in the study of Sörös et al no definition of malnutrition was provided [4] . Interestingly we found that although patients with and without low fat or muscle mass did not differ in number connection A performance times, a recent weight loss was related to longer performance times [81 s (51) vs 54 s (32), P = 0.001] [5] . It is therefore conceivable that deterioration in nutritional status, rather than nutritional status itself, may be of great importance for cognitive dysfunction in patients with liver cirrhosis.…”

Section: Introductionmentioning

confidence: 83%

“…Patients with malnutrition suffered more frequently from HE compared to those without malnutrition (46% vs 27%, P = 0.031) , but there was no difference in age, etiology, or severity of liver cirrhosis. In multivariate analysis, the time needed to perform number connection test A was independently correlated to age, severity of cirrhosis expressed as the Child-Pugh score, diabetes and malnutrition [5] . This is in agreement with a previous study showing that diabetes mellitus is associated with HE in patients with hepatitis C cirrhosis [6] .…”

Section: Introductionmentioning

confidence: 99%

“…In multivariate analysis none of these parameters was found to be independently related to HE. The authors concluded that malnutrition or catabolism does not seem to be independent risk factors for the presence of HE in patients with liver cirrhosis [4] .Recently, we performed a prospective study evaluating HE in 128 patients with liver cirrhosis of various etiologies [5] . HE was evaluated by means of the West Haven criteria and two psychometric tests (number connection test A and B).…”

mentioning

confidence: 99%

“…Recently, we performed a prospective study evaluating HE in 128 patients with liver cirrhosis of various etiologies [5] . HE was evaluated by means of the West Haven criteria and two psychometric tests (number connection test A and B).…”

mentioning

confidence: 99%

See 4 more Smart Citations

Hepatic encephalopathy in patients with liver cirrhosis: Is there a role of malnutrition?

Kalaitzakis¹,

Björnsson²

2008

WJG

Self Cite

View full text Add to dashboard Cite

The pathogenesis of hepatic encephalopathy (HE), a common complication of liver cirrhosis, remains incompletely understood but it is probably multifactorial in most cases [1] . Malnutrition is also commonly encountered in patients with cirrhosis and it has been reported to have an effect on health related quality of life [2] . Although experimental studies suggest that low energy intake and poor nutritional status may facilitate the development of HE [3] , there are scarce data on the potential role of malnutrition in HE in patients with liver cirrhosis.Recently Soros et al [4] performed a study investigating the potential role of malnutrition and hypermetabolism in HE in which 223 patients with non-alcoholic cirrhosis were enrolled. They were evaluated for the presence of HE according to the West Haven criteria and for malnutrition by means of body mass index (BMI), anthropometric measurements, and bioelectrical impedance analysis. Energy metabolism was also assessed by means of indirect calorimetry. Eighty-five (38%) out of 223 patients had no clinically evident HE, 123/223 (55%) had HE grade 1 and 15/223 (7%) had HE grade 2 or 3. Neither metabolic variables or BMI nor fat free mass or muscle mass differed significantly in patients with HE grade 1-3 from those without HE. In multivariate analysis none of these parameters was found to be independently related to HE. The authors concluded that malnutrition or catabolism does not seem to be independent risk factors for the presence of HE in patients with liver cirrhosis [4] .Recently, we performed a prospective study evaluating HE in 128 patients with liver cirrhosis of various etiologies [5] . HE was evaluated by means of the West Haven criteria and two psychometric tests (number connection test A and B). HE was defined as overt HE according to the West Haven criteria and/or number connection test A and/or B > 3 standard deviations of the general population. Nutritional status was evaluated with BMI and anthropometric measurement as well as estimation of recent weight change. Malnutrition was defined as anthropometric measurement below the 5th AbstractHepatic encephalopathy (HE) is a common complication in patients with liver cirrhosis but its pathogenesis remains incompletely understood. Malnutrition is commonly encountered in patients with liver cirrhosis and it has been reported to affect the quality of life of this group of patients. Experimental studies suggest that low energy intake and poor nutritional status may facilitate the development of HE but there are scarce data on the potential role of malnutrition in HE in patients with liver cirrhosis. Two recently published studies have evaluated the potential role of malnutrition in the development of HE in cirrhotic patients with conflicting results. In this letter to the editor we briefly present the results of the two studies as well as potential reasons for the conflicting results reported.

show abstract

Section: Introductionmentioning

confidence: 67%

Section: Introductionmentioning

confidence: 83%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Hepatic encephalopathy in patients with liver cirrhosis: Is there a role of malnutrition?

Kalaitzakis¹,

Björnsson²

2008

WJG

Self Cite

View full text Add to dashboard Cite

show abstract

Acute‐on‐Chronic Liver Failure

Wong

2017

Schiff's Diseases of the Liver

View full text Add to dashboard Cite

New‐onset diabetes increases risk of hepatic encephalopathy in cirrhotics with ascites: A nationwide cohort study

Huang

Lee

et al. 2019

Adv in Digestive Medicine

View full text Add to dashboard Cite

Hepatic encephalopathy (HE) is a major complication of cirrhosis, and the management of HE is an important issue. The link between new‐onset diabetes and the risk of HE in cirrhotic patients with ascites remains unclear. We aimed to evaluate the risk of HE in cirrhotic patients with new‐onset diabetes. The Taiwanese National Health Insurance Research Database comprises records of more than 99% of the entire population. Among randomly sampled one million enrollees, 4503 cirrhotic patients with ascites were enrolled. New‐onset diabetes was defined as patients who were given the diagnosis in the years 1999 to 2009 but not in 1997 to 1998. The cohorts of cirrhotic patients with new‐onset diabetes (n = 462) and 1:1 ratio age‐, gender‐, and inception point (onset date of diabetes)‐matched nondiabetes (n = 462) were followed up from the inception point until development of HE, withdrawal from insurance, or December 2009. The Cox proportional hazard model was used to evaluate HE risk associated with new‐onset diabetes in the study cohort. Cumulative incidence curve and Gray's test were used to explore the difference in the risk distribution by considering death a competing risk. Patients with new‐onset diabetes had a significantly higher cumulative incidence of HE (P = 0.03) compared to nondiabetes patients. After adjustment for age, gender, comorbidity index, decompensated cirrhosis, obesity, hypertension, hyperlipidemia, sepsis, hepatitis C infection, chronic pancreatitis, lactulose use after HE diagnosis, benzodiazepine/barbiturate, spironolactone, furosemide, potassium‐sparing diuretic, and diabetes treatment, diabetes was still an independent predictor for HE (hazard ratio = 1.920, 95% confidence interval = 1.135‐3.246, P = 0.02). Cirrhotic patients with ascites who develop newly diagnosed diabetes have an increased risk of HE.

show abstract

Malnutrition and diabetes mellitus are related to hepatic encephalopathy in patients with liver cirrhosis

Abstract: Malnutrition and diabetes mellitus seem to be related to HE in patients with liver cirrhosis. Nutritional status and insulin resistance might be implicated in the pathogenesis of HE.

Cited by 100 publications

References 42 publications

Hepatic encephalopathy in patients with liver cirrhosis: Is there a role of malnutrition?

Hepatic encephalopathy in patients with liver cirrhosis: Is there a role of malnutrition?

Acute‐on‐Chronic Liver Failure

New‐onset diabetes increases risk of hepatic encephalopathy in cirrhotics with ascites: A nationwide cohort study

Contact Info

Product

Resources

About