title: 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: OBJECTIVE
  Problems in patients with minimal hepatic encephalopathy (MHE) include episodes such as falls and deficient driving skills, without any recognition of neurophysiological dysfunction. Patients with MHE are also more likely to develop overt hepatic encephalopathy. However, there is not yet any interventional strategy for MHE involving nutritional management. We conducted a preliminary study to investigate the proportion of positive MHE and the effects of nutritional management on MHE.
  
  
  METHODS
  Patients with viral liver cirrhosis and abnormal neuropsychological tests were included. Nutritional consultations were conducted periodically by a dietitian, who recommended 30-35 kcal with 1.0-1.5 g of protein/kg of ideal bodyweight/day. The primary end-point was to evaluate the proportion of patients who recovered from MHE. The secondary end-point was to evaluate the improvement in the patients' quality of life (QOL).
  
  
  RESULTS
  Thirty-two (30.1%) of 106 patients were diagnosed with MHE. Nineteen patients were enrolled in the study. Eleven of 19 patients became non-MHE after 4 weeks, and 13 of 19 patients (68.4%, P < 0.001) after 8 weeks. The mental summary scores were significantly improved at 8 weeks (P = 0.0413). Changes in albumin levels from week 0 to week 8 were 0.15 ± 0.16 g/dL in the improved MHE group and -0.28 ± 0.33 g/dL in the non-improved MHE group, which differ significantly (P = 0.0130).
  
  
  CONCLUSIONS
  Periodical nutritional management improved MHE and QOL. Improving the patient's nutritional condition may be one approach to treating MHE.
authors.affiliation: Department of Internal Medicine, Division of Gastroenterology and Hepatology, Iwate Medical University, Iwate.
authors.forename: Akinobu
authors.initials: A
authors.lastname: Kato
authors.forename: Hiroto
authors.initials: H
authors.lastname: Tanaka
authors.forename: Takumi
authors.initials: T
authors.lastname: Kawaguchi
authors.forename: Hidenori
authors.initials: H
authors.lastname: Kanazawa
authors.forename: Motoh
authors.initials: M
authors.lastname: Iwasa
authors.forename: Isao
authors.initials: I
authors.lastname: Sakaida
authors.forename: Hisataka
authors.initials: H
authors.lastname: Moriwaki
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Murawaki
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Suzuki
authors.forename: Kiwamu
authors.initials: K
authors.lastname: Okita