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

Abstract

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.

Expectations of patients with hepatitis C from family physicians – a Polish example

“…According to Johnson et al, anti-health eating habits hinder the process of treatment. The lack of observance of diet and malnutrition of patients with cirrhosis of the liver significantly deteriorate the clinical status of this organ [29]. It was observed that patients who were ordered a special diet after the diagnosis of hepatitis C, to a higher degree expected emotional support (7.23 scores), compared to those who did not receive dietary recommendations (6.39 scores; p>0.05).…”

Old and New Precipitants in Hepatic Encephalopathy: A New Look at a Field in Continuous Evolution

“…Since malnutrition worsens the prognosis, in addition to the treatment of the underlying causes of cirrhosis and its complications when they occur, an early assessment of nutritional status should be performed in these patients [64]. Nowadays, both instrumental and non-instrumental tools are available to asses nutritional status in cirrhotic patients, such as the bioimpedance test, handgrip strength, DEXA and computed tomography scans for the first category, and food diaries, objective examinations, biochemical parameters (level of total plasma protein), anthropometric measurements, the creatine-to-weight ratio and subjective global assessment questionnaires in the latter category [65]. As well as nutritional assessments, dietary control is a valid tool to improve nutritional status and prognosis.…”

Current Management of Hepatic Encephalopathy: A Review Article

“…There is no evidence suggesting that restricting dietary protein prevents episodes of HE. The daily calorie requirement falls within the range of 35 to 45 kcal/gm, while the protein requirement is recommended to be 1.2 to 1.5 gm/kg of body weight per day 26,27 .…”