Effect of total enteral nutrition on the short-term outcome of severely malnourished cirrhotics

Cabré, Eduard; González-Húix, Ferrán; Abad-Lacruz, A; Estève, M.; Acero, Doroteo; Fernández‐Bañares, Fernando; Xiol, Xavier; Gassull, Miquel A.

doi:10.1016/0016-5085(90)90293-a

Cited by 307 publications

(164 citation statements)

References 23 publications

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“…In short term studies, Cabre et al (111) and Kearns et al (112) demonstrated that enteral feeding for 3-4 wk in hospitalized, severely malnourished or decompensated cirrhotic patients improved survival (p Ͻ 0.065), hepatic encephalopathy, liver function, and Child's score (which is a composite grading of severity based on abnormalities in albumin, bilirubin, prothrombin time, encephalopathy, and ascites) as compared with controls receiving a standard oral diet. In another short term study (113), nutritional support after liver transplantation produced better nitrogen balance, significantly shortened time spent in the intensive care unit, and quantitatively decreased hospital cost and length of stay.…”

Section: Nutritional Therapymentioning

confidence: 99%

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

McCullough

O’Connor

1998

American Journal of Gastroenterology

229

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PREAMBLEGuidelines for clinical practice are intended to suggest preferable approaches to particular medical problems as established by interpretation and collation of scientifically valid research, derived from extensive review of published literature. When data are not available that will withstand objective scrutiny, a recommendation may be made based on a consensus of experts. Guidelines are intended to apply to the clinical situation for all physicians without regard to specialty. Guidelines are intended to be flexible, not necessarily indicating the only acceptable approach, and should be distinguished from standards of care that are inflexible and rarely violated. Given the wide range of choices in any health care problem, the physician should select the course best suited to the individual patient and the clinical situation presented.These guidelines are developed under the auspices of the American College of Gastroenterology and its Practice Parameters Committee. These guidelines are also approved by the governing boards of the American Gastroenterological Association and the American Association for the Study of Liver Disease. Expert opinion is solicited from the outset for the document. Guidelines are reviewed in depth by the Committee, with participation from experienced clinicians and others in related fields. The final recommendations are based on the data available at the time of the production of the document and may be updated with pertinent scientific developments at a later time.Objective: The objective of this work was to develop practice guidelines for the management of alcoholic liver disease. Method: A computerized search using the Medline Data Base from 1966 -July 1997 was performed with the search headings; alcohol, alcoholic hepatitis, alcoholic liver disease, liver transplant, diagnosis, epidemiology, human, and English only. All randomized controlled trials, case-control studies, and meta-analyses were read in depth. A manual search was also done using references from each retrieved report, review articles, editorials, postgraduate course syllabi, and textbooks. In the subsequent review, evidence was evaluated using a hierarchical scale with randomized, controlled trials given the most importance. Abstracts presented at national meetings were included only when unique data were obtained from those studies. (Am J Gastroenterol 1998;93:2022-2036.

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Section: Nutritional Therapymentioning

confidence: 99%

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

McCullough

O’Connor

1998

American Journal of Gastroenterology

229

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“…11 Poor dietary intake in patients with chronic liver disease has been identified as a major concern and one that is difficult to resolve. [12][13] This may, in part, be a result of the complex interaction between aberrant metabolism occurring in liver disease and ingestive behavior.…”

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confidence: 99%

Macronutrient Preference, Dietary Intake, and Substrate Oxidation Among Stable Cirrhotic Patients

et al. 1999

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Anorexia in liver disease is common; however, its association with aberrant metabolism and the type of cirrhosis has not been considered. Dietary intake, nutritional status, fasting substrate oxidation, and macronutrient preference were examined in controls (n ‫؍‬ 18) and 65 patients with hepatocellular (n ‫؍‬ 31) or biliary cirrhosis (n ‫؍‬ 34). Energy intakes were lowest in hepatocellular patients (

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“…Protein in older cirrhotic adults of HE [37][38][39][40] . Similar studies continued in the 1990's, showing that higher amounts of protein intake do not lead to worsening of hepatic encephalopathy [41,42,45] . In 2004 and 2005, two more studies were done to completely remove any doubt as to whether or not dietary protein is harmful in HE.…”

mentioning

confidence: 58%

“…Since the 1970's, multiple studies have been done that have proven that protein restriction is not beneficial in HE; a summary of these studies can be found in table 1 [24,[36][37][38][39][40][41][42][43][44][45] . As far back as 1977,…”

Section: Effects Of Protein Restrictions On Progression Of Liver Diseasementioning

confidence: 99%

Protein Recommendations for Older Adults with Cirrhosis: A Review

Iiames

Logomarsino

2015

Journal of Gastroenterology and Hepatology Research

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Protein intake has a key role in liver cirrhosis in older adults. However, types and amounts of protein intake in cirrhosis have been controversial. The aim of this paper is to investigate the optimal protein intake for management of cirrhosis and prevention of hepatic encephalopathy in older adults. Protein restriction of 0.6 g/kg/d has traditionally been used as medical nutrition therapy in liver cirrhosis. However, recent evidence has shown that protein restrictions have many negative consequences for older adults with cirrhosis. Current research indicates protein intakes of 1.2-1.5 g/ kg/d in liver cirrhosis; however, many older adults do not consume this amount. Strategies to help increase protein intake and manage cirrhosis include ensuring adequate protein at every meal through either regular intake or supplementation, protein supplementation prior to bedtime or overnight, and supplementation with branchedchain amino acids. An emphasis on vegetable protein versus animal protein is probably not an advantageous treatment option because of lack of conclusive evidence regarding benefits and potential negative side effects. and progression of chronic liver disease and cirrhosis.There are several different factors that naturally occur in older adulthood that help contribute to the development of chronic liver disease and cirrhosis. After reaching maximum size in early adulthood, the liver steadily decreases in both size and the amount of blood flow it receives, leading to decreased function and efficiency over time [10] . Also, increased ammonia production and bacterial overgrowth are common in older adulthood, both of which are thought to play a key role in development of hepatic encephalopathy [11] . Older adults tend to have chronic constipation, intestinal dysmotility, and increased colonic transit time, which predisposes them to increased ammonia production [12] . Finally, older adulthood is associated with a higher incidence of diabetes, which is strongly correlated to progression of liver cirrhosis [13] . Pathogenesis of malnutrition in older adults with cirrhosisIt is estimated that 20% of patients with compensated cirrhosis and 60% of patients with decompensated cirrhosis have malnutrition [14] . In older adults, protein energy malnutrition is associated with high health care costs, increased frequency of infection and bedsores, increased morbidity and mortality, and poor physical functioning [4,5] . In canine trials, poor nutritional status has been shown to encourage the development of hepatic encephalopathy [15] . In addition, malnutrition in cirrhosis is positively associated with old age [14] . Multiple factors help contribute to the development of malnutrition in older adults with cirrhosis, including inadequate intake, altered absorption, sarcopenia, and altered metabolism. All causes must be explored and taken into consideration when developing treatment and prevention strategies.In older adults, food intake naturally decreases over time [16] , which promotes the development of malnutri...

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Effect of total enteral nutrition on the short-term outcome of severely malnourished cirrhotics

Cited by 307 publications

References 23 publications

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

Alcoholic liver disease: proposed recommendations for the American College of Gastroenterology

Macronutrient Preference, Dietary Intake, and Substrate Oxidation Among Stable Cirrhotic Patients

Protein Recommendations for Older Adults with Cirrhosis: A Review

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