Normal protein diet for episodic hepatic encephalopathy: results of a randomized study.
OBJECTIVE
Protein-restricted diets are usually prescribed for cirrhotic patients with hepatic encephalopathy. However, protein restriction may worsen the nutritional status without resulting in an improvement of hepatic encephalopathy. We designed a study to assess the effects of the amount of protein in the diet on the evolution of episodic hepatic encephalopathy.


METHODS
Cirrhotics admitted to the hospital because of an episode of encephalopathy (n=30) were randomized to receive a low-protein diet with progressive increments or a normal protein diet for 14 days, in addition to standard measures to treat hepatic encephalopathy. Protein synthesis and breakdown were studied at day 2 and day 14 with the glycine-N(15) infusion method.


RESULTS
The outcome of hepatic encephalopathy was not significantly different between both groups of treatment. Protein synthesis was similar for low and normal protein diet, but those of the low-protein diet group showed higher protein breakdown.


CONCLUSIONS
Diets with a normal content of protein, which are metabolically more adequate, can be administered safely to cirrhotic patients with episodic hepatic encephalopathy. Restriction of the content of protein of the diet does not appear to have any beneficial effect for cirrhotic patients during an episode of encephalopathy.
Córdoba
Juan
J
Servei de Medicina Interna-Hepatologia, Hospital Universitari Vall d'Hebron, Barcelona, Universitat Autònoma de Barcelona, Barcelona, Spain. jcordoba@vhebron.net
López-Hellín
Juan
J
Planas
Mercé
M
Sabín
Pilar
P
Sanpedro
Francesc
F
Castro
Francisco
F
Esteban
Rafael
R
Guardia
Jaume
J
D000368:Aged; D000641:Ammonia / Q000097:blood; D001663:Bilirubin / Q000097:blood; D018753:Diet, Protein-Restricted; D004044:Dietary Proteins / Q000008:administration & dosage* / Q000493:pharmacokinetics; D005260:Female; D006501:Hepatic Encephalopathy / Q000178:diet therapy* / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D011516:Prothrombin / Q000378:metabolism; D012709:Serum Albumin
D004044:Dietary Proteins; D012709:Serum Albumin; D000641:Ammonia; D011516:Prothrombin; D001663:Bilirubin