Nutritional pharmacotherapy of chronic liver disease: from support of liver failure to prevention of liver cancer.
Many patients with liver cirrhosis are in a state of protein and energy malnutrition and require careful nutritional support. Our research has revealed that approximately 30% of the patients have protein-energy malnutrition, 40% protein malnutrition, and 10% energy malnutrition; 20% are in a normal nutritional state. Supplementation with branched-chain amino acids alleviates chronic liver failure, improves the protein nutritional state, and subsequently prolongs survival. In contrast, therapeutic modalities for energy malnutrition have not yet been fully elucidated and await further studies. Improved survival of the cirrhotic patients essentially brings a higher incidence of hepatocellular carcinoma (HCC). A synthetic analogue of vitamin A (acyclic retinoid or 4,5-dehydrogeranyl geranoic acid) prevents at least the development of second primary tumors after curative treatment of preceding HCC. The mechanism of this cancer chemo-prevention is clonal deletion of premalignant and latent malignant cells by the retinoid. We describe our clinical experiences with these two nutritional pharmacotherapies of chronic liver diseases and review their basic mechanisms.
Moriwaki
H
H
First Department of Internal Medicine, Gifu University School of Medicine, Japan.
Tajika
M
M
Miwa
Y
Y
Kato
M
M
Yasuda
I
I
Shiratori
Y
Y
Okuno
M
M
Kato
T
T
Ohnishi
H
H
Muto
Y
Y
D000597:Amino Acids, Branched-Chain / Q000008:administration & dosage; D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000517:prevention & control*; D002471:Cell Transformation, Neoplastic / Q000187:drug effects; D003131:Combined Modality Therapy; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality / Q000628:therapy*; D017093:Liver Failure / Q000401:mortality / Q000628:therapy*; D008113:Liver Neoplasms / Q000401:mortality / Q000517:prevention & control*; D018529:Nutritional Support; D011502:Protein-Energy Malnutrition / Q000401:mortality / Q000628:therapy; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome; D014212:Tretinoin / Q000008:administration & dosage / Q000031:analogs & derivatives
D000597:Amino Acids, Branched-Chain; D000970:Antineoplastic Agents; D014212:Tretinoin; C034534:3,7,11,15-tetramethyl-2,4,6,10,14-hexadecapentaenoic acid