Nutritional management contributes to improvement in minimal hepatic encephalopathy and quality of life in patients with liver cirrhosis: A preliminary, prospective, open‐label study

Kato, Akinobu; Tanaka, Hiroto; Kawaguchi, Takumi; Kanazawa, Hideko; Iwasa, Motoh; Sakaida, Isao; Moriwaki, Hisataka; Murawaki, Yoshikazu; Suzuki, Kazuyuki; Okita, Kiwamu

doi:10.1111/j.1872-034x.2012.01092.x

Cited by 47 publications

(50 citation statements)

References 27 publications

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“…Furthermore, optimization of the patient´s nutritional condition conducted periodically by a nutritionist has shown benefit in terms of cognitive performance and HR-QoL. 60 …”

Section: Discussionmentioning

confidence: 99%

Minimal Hepatic Encephalopathy: The Reality Beyond Our Eyes

et al. 2015

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RESUMOIntrodução: A encefalopatia hepática mínima define-se como um défice neurocognitivo ligeiro, não detectável ao exame clínico, que pode estar presente nos doentes cirróticos. Objectivo: Determinar a prevalência da encefalopatia hepática mínima num hospital prestador de cuidados de saúde secundários no Norte de Portugal. Material e Métodos: Realizou-se um estudo transversal em que foram incluídos os doentes cirróticos seguidos na consulta externa. Critérios de exclusão: encefalopatia hepática clínica, iliteracia, consumo activo de álcool e terapêutica com fármacos psicotrópicos ou lactulose. A presença de encefalopatia hepática mínima foi definida como um valor ≤ -4 na Pontuação Psicométrica da Encefalopatia Hepática, calculado de acordo com as normas portuguesas. Analisaram-se as variáveis: etiologia e gravidade da doença hepática e concentração da amónia sanguínea venosa. Considerou-se o valor de p < 0,05 como significativo. Resultados: Dos 102 doentes avaliados, 41 foram incluídos: 31 homens, idade média de 57 ± 10 anos, escolaridade média de 5 ± 2 anos, 31 Child-Pugh classe A, score MELD médio de 6 ± 3. Foi diagnosticada encefalopatia hepática mínima em 14 (34%) doentes. A presença de encefalopatia hepática mínima não se relacionou com a gravidade da doença hepática. Apesar de mais elevado, o valor médio da concentração da amónia venosa nos doentes com encefalopatia hepática mínima não foi significativamente diferente do valor médio da concentração da amónia venosa nos doentes sem encefalopatia hepática mínima (48,5 ± 13,3 vs. 45,6 ± 15,6 µmol/L, p = 0,555). Discussão: A prevalência da encefalopatia hepática mínima descrita está de acordo com os dados internacionais. Conclusão: A encefalopatia hepática mínima é uma entidade frequente que está presente precocemente na história natural da cirrose, mesmo em doentes compensados. Consequentemente, esta condição escondida deve ser activamente procurada e os doentes devidamente orientados após o diagnóstico. Palavras-chave: Cirrose Hepática; Encefalopatia Hepática; Psicometria; Testes Neuropsicológicos. ABSTRACT Introduction:Minimal hepatic encephalopathy refers to a mild neurocognitive impairment not detectable by clinical examination that can be present in cirrhotic patients. Aim: To determine the prevalence of minimal hepatic encephalopathy in a secondary healthcare center in Northern Portugal. Material and Methods: A cross-sectional study was conducted. Cirrhotic outpatients were included. Exclusion criteria: overt hepatic encephalopathy, illiteracy, active alcohol consumption, psychotropic drug use and therapy with lactulose. The presence of minimal hepatic encephalopathy was defined as a value ≤ -4 on the Psychometric Hepatic Encephalopathy Score, calculated according to the Portuguese norms. Variables analyzed: etiology and severity of liver disease and venous blood ammonia concentration. p values < 0.05 were considered significant. Results: From the 102 patients who were evaluated, 41 were included: 31 males, mean age 57 ± 10 years, mean education 5 ± 2...

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“…Furthermore, optimization of the patient´s nutritional condition conducted periodically by a nutritionist has shown benefit in terms of cognitive performance and HR-QoL. 60 …”

Section: Discussionmentioning

confidence: 99%

Minimal Hepatic Encephalopathy: The Reality Beyond Our Eyes

et al. 2015

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“…However, it is critical to diagnose MHE in patients with cirrhosis, as MHE is a risk factor for OHE (9), reduces the 5-year survival rate for cirrhosis (10), impairs the ability of an individual to drive a vehicle (11), increases the incidence of motor vehicle accidents (12,13) and increases the risk of falls (14). Furthermore, MHE is a highly prevalent cognitive disorder that severely affects the health-related quality of life for individuals (15 30.1% of cirrhotic patients in Japan (16). It shows that MHE is not a rare condition in liver cirrhosis.…”

Section: Introductionmentioning

confidence: 99%

Screening for minimal hepatic encephalopathy in patients with cirrhosis by cirrhosis-related symptoms and a history of overt hepatic encephalopathy

et al. 2016

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Abstract. The diagnosis of minimal hepatic encephalopathy (MHE) is more difficult in comparison to the diagnosis of overt hepatic encephalopathy (OHE), as patients with MHE do not exhibit overt neurological deficits and must be diagnosed using specialized equipment. However, identifying MHE is critical for patients with cirrhosis, and a simple screening test is required. The present study aimed to evaluate the associations between MHE, clinical characteristics and questionnaire items regarding sleep disturbances and cirrhosis-related symptom score (CSS). A total of 91 patients who had cirrhosis without OHE were evaluated using various questionnaires [i.e., CSS, Epworth Sleepiness Scale, the Japanese version of the Pittsburgh Sleep Quality Index (PSQI) and the Japanese 36-item short-form health survey (SF-36)]. MHE was diagnosed using the neuropsychological test. MHE was associated with severe liver damage, which was indicated by liver damage markers and a history of OHE. In addition, MHE was associated with the CSS, PSQI and SF-36 results. The multivariate analyses revealed that a history of OHE was the factor that was the most strongly associated with MHE. Among patients without a history of OHE, MHE was most strongly associated with CSS, although it was also associated with severe liver damage and platelet counts. A prediction score (calculated using a history of OHE and CSS) provided an area under the receiver operating characteristic curve of 0.738 and a sensitivity of 0.671 for identifying MHE. In conclusion, a history of OHE and CSS may be useful for identifying MHE in patients with cirrhosis.

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“…Подобное снижение концентрации аминокислот также продемонстрировано в работах с хроническим воздействием больших доз ал-коголя (Jang et al, 2012;Shayakhmetova et al, 2015). При этом в ряде работ показано положительное влияние на метаболизм печени увеличения в рационе питания BCAA (Malaguarnera et al, 2009;Kato et al, 2013).…”

Section: Discussionunclassified

NMR metabolic profiling of the liver following administrationof alcohol andthemushroom Ganoderma lucidum in rats

Крестина¹,

Шевелев²,

Коптюг³

et al. 2015

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Nutritional management contributes to improvement in minimal hepatic encephalopathy and quality of life in patients with liver cirrhosis: A preliminary, prospective, open‐label study

Abstract: Periodical nutritional management improved MHE and QOL. Improving the patient's nutritional condition may be one approach to treating MHE.

Cited by 47 publications

References 27 publications

Minimal Hepatic Encephalopathy: The Reality Beyond Our Eyes

Minimal Hepatic Encephalopathy: The Reality Beyond Our Eyes

Screening for minimal hepatic encephalopathy in patients with cirrhosis by cirrhosis-related symptoms and a history of overt hepatic encephalopathy

NMR metabolic profiling of the liver following administrationof alcohol andthemushroom Ganoderma lucidum in rats

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