Diet and cognition in chronic liver disease.
OBJECTIVE
The spectrum of neurocognitive impairment in cirrhosis spans a continuum of minimal hepatic encephalopathy (MHE) to overt hepatic encephalopathy (OHE), the pathophysiology of which remains incompletely understood. The current available evidence, however, suggests that nutrition plays an important role in its development and points to the fact that malnutrition increases the morbidity and mortality of patients with cirrhosis. This review incorporates recent findings published in the last 2 years within the evolution of evidence regarding the role dietary manipulation can play in the comprehensive management of patients with cirrhosis and cognitive dysfunction.


RESULTS
In patients with cirrhosis it is important to prevent starvation physiology which occurs after few hours of caloric deprivation as compared to 3 days in noncirrhotics. This can be accomplished by making sure that cirrhotic patients have daily breakfast and a late evening snack. In addition, probiotics and symbiotics are well tolerated and improve cognitive function in patients with MHE.


CONCLUSIONS
The long-time held belief that protein restriction is needed to improve encephalopathy has no scientific basis but remains widely practiced. Branched-chain amino acids supplement may be helpful in patients who continue to suffer from OHE despite treatment of precipitating events and pharmacologic treatment with lactulose and rifaximin. Preventing starvation physiology and supplementing the diet with prebiotics and symbiotics are helpful in patients with MHE.
Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA.
Toufic
T
Kachaamy
Jasmohan S
JS
Bajaj
D000597:Amino Acids, Branched-Chain / Q000627:therapeutic use; D003072:Cognition Disorders / Q000178:diet therapy* / Q000209:etiology / Q000503:physiopathology; D018753:Diet, Protein-Restricted; D006501:Hepatic Encephalopathy / Q000178:diet therapy* / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000178:diet therapy*; D044342:Malnutrition / Q000150:complications*; D056692:Prebiotics; D019936:Probiotics / Q000627:therapeutic use; D013217:Starvation / Q000503:physiopathology / Q000517:prevention & control
D000597:Amino Acids, Branched-Chain; D056692:Prebiotics