title: Nutritional therapy in cirrhosis or alcoholic hepatitis: a systematic review and meta-analysis.
abstract: OBJECTIVE
  Patients with cirrhosis and alcoholic hepatitis are often malnourished and have a superimposed stress metabolism, which increases nutritional demands. We performed a systematic review on the effects of nutritional therapy vs. no intervention for patients with cirrhosis or alcoholic hepatitis.
  
  
  METHODS
  We included trials on nutritional therapy designed to fulfil at least 75% of daily nutritional demand. Authors extracted data in an independent manner. Random-effects and fixed-effect meta-analyses were performed and the results expressed as risk ratios (RR) with 95% confidence intervals (CI). Sequential analyses were performed to evaluate the risk of spurious findings because of random and systematic errors. Subgroup and sensitivity analyses were performed to evaluate the risk of bias and sources of between trial heterogeneity.
  
  
  RESULTS
  Thirteen randomized controlled trials with 329 allocated to enteral (nine trials) or intravenous (four trials) nutrition and 334 controls. All trials were classed as having a high risk of bias. Random-effects meta-analysis showed that nutritional therapy reduced mortality 0.80 (95% CI, 0.64 to 0.99). The result was not confirmed in sequential analysis. Fixed-effect analysis suggested that nutrition prevented overt hepatic encephalopathy (0.73; 95% CI, 0.55 to 0.96) and infection (0.66; 95% CI, 0.45 to 0.98, respectively), but the results were not confirmed in random-effects analyses.
  
  
  CONCLUSIONS
  Our review suggests that nutritional therapy may have beneficial effects on clinical outcomes in cirrhosis and alcoholic hepatitis. High-quality trials are needed to verify our findings.
authors: Department of Gastroenterology and Hepatology, Odense University Hospital, Odense C, Denmark.
authors: Annette D
authors: AD
authors: Fialla
authors: Department of Gastroenterology and Hepatology, Odense University Hospital, Odense C, Denmark.
authors: Mads
authors: M
authors: Israelsen
authors: Department of Hepatology, Copenhagen University Hospital Rigshospitalet, Koebenhavn, Denmark.
authors: Ole
authors: O
authors: Hamberg
authors: Department of Gastroenterology and Hepatology, Odense University Hospital, Odense C, Denmark.
authors: Aleksander
authors: A
authors: Krag
authors: Gastrounit, Medical Division, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark.
authors: Lise Lotte
authors: LL
authors: Gluud
mesh_terms: D002149:Energy Intake; D006501:Hepatic Encephalopathy / Q000517:prevention & control*; D006519:Hepatitis, Alcoholic / Q000178:diet therapy*; D006801:Humans; D008103:Liver Cirrhosis / Q000178:diet therapy*; D044623:Nutrition Therapy; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic
keywords: alcoholic hepatitis; cirrhosis; meta-analysis; nutritional therapy