title: Dietary management of hepatic encephalopathy revisited.
abstract: OBJECTIVE
  The burden of hepatic encephalopathy on health services is increasing, and some degree of consensus in relation to drug therapy and prophylaxis has been reached. This review focuses on the role of nutritional interventions in the management of hepatic encephalopathy.
  
  
  RESULTS
  A number of relatively new pieces of evidence are emerging in relation to nutrition and hepatic encephalopathy as follows: first, reduction of protein intake is not useful for hepatic encephalopathy, but protein selection should be considered; second, oral supplementation with branched chain amino acids has a role not only for its nutritional effect in cirrhosis per se, but also for its effect in reducing the risk of recurrence of hepatic encephalopathy; third, alterations in gut microbiota develop in parallel with decompensation of cirrhosis, and modulation of gut microbiota may be effective for treating and preventing hepatic encephalopathy; fourth, prebiotics and probiotics are potentially useful in this aim, thus further research or trials on prebiotics and probiotics are required; fifth, micronutrient deficiency, which is common in end-stage liver disease, has adverse effects on the brain and may either directly cause encephalopathy per se, or interact with the mechanisms leading to hepatic encephalopathy.
  
  
  CONCLUSIONS
  Properly performed nutritional interventions are likely to be useful for patients with hepatic encephalopathy, but well conducted clinical trials are required.
  http://links.lww.com/COCN/A7.
authors.affiliation: Department of Medicine - DIMED, University of Padova, Padova, Italy.
authors.forename: Piero
authors.initials: P
authors.lastname: Amodio
authors.forename: Fabio
authors.initials: F
authors.lastname: Canesso
authors.forename: Sara
authors.initials: S
authors.lastname: Montagnese
mesh_terms: D000597:Amino Acids, Branched-Chain / Q000627:therapeutic use*; D004043:Dietary Fiber / Q000627:therapeutic use*; D004044:Dietary Proteins / Q000008:administration & dosage; D019587:Dietary Supplements; D041981:Gastrointestinal Tract / Q000382:microbiology*; D006501:Hepatic Encephalopathy / Q000178:diet therapy* / Q000382:microbiology; D006801:Humans; D008103:Liver Cirrhosis / Q000178:diet therapy / Q000382:microbiology; D018977:Micronutrients / Q000172:deficiency / Q000627:therapeutic use*
chemical_list: D000597:Amino Acids, Branched-Chain; D004043:Dietary Fiber; D004044:Dietary Proteins; D018977:Micronutrients