title: Nutrition in hepatic encephalopathy.
abstract: Protein calorie malnutrition (PCM) is a well-known complication of chronic liver disease (CLD). A major contribution to PCM in CLD is restriction of dietary protein intake. After many decades of injudicious reduction in dietary protein, cirrhotic patients are now prescribed appropriate amounts of protein. PCM in CLD is known to be associated with life-threatening complications. In the general approach to these patients, the initial and most important step for the clinician is to recognize the extent of malnutrition. Most patients tolerate a normal amount of dietary protein without developing hepatic encephalopathy (HE). Oral branched-chain amino acids (BCAAs) have a limited role in HE. Patients who exhibit dietary protein intolerance originally were thought to be best treated with BCAA formulations. Mixed evidence has been reported in multiple studies. In keeping with other reports, this article shows that in animal protein-intolerant patients, even those with advanced cirrhosis, vegetable protein-based diets are well tolerated. Another approach to management of apparent dietary intolerance is to optimize HE treatment with available medications. This article reviews the causes of HE, minimal HE, and PCM; examines nutrition requirements and assessment; and discusses treatment options for malnutrition in HE.
authors.affiliation: Division of Gastroenterology, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
authors.forename: Rajagopal
authors.initials: R
authors.lastname: Chadalavada
authors.forename: Raja Shekhar
authors.initials: RS
authors.lastname: Sappati Biyyani
authors.forename: John
authors.initials: J
authors.lastname: Maxwell
authors.forename: Kevin
authors.initials: K
authors.lastname: Mullen
mesh_terms: D000596:Amino Acids / Q000627:therapeutic use*; D000818:Animals; D004044:Dietary Proteins / Q000627:therapeutic use*; D005355:Fibrosis / Q000178:diet therapy; D006501:Hepatic Encephalopathy / Q000178:diet therapy* / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000178:diet therapy; D011502:Protein-Energy Malnutrition / Q000178:diet therapy* / Q000209:etiology
chemical_list: D000596:Amino Acids; D004044:Dietary Proteins