Postprandial Effects Of Calcium Phosphate Supplementation On Plasma Concentration-double-blind, Placebo-controlled Crossover Human Study

Abstract

Malnutrition is common in patients with end-stage liver failure and hepatic encephalopathy, and is considered a significant prognostic factor affecting quality of life, outcome, and survival. The liver plays a crucial role in the regulation of nutrition by trafficking the metabolism of nutrients, their distribution and appropriate use by the body. Nutritional consequences with the potential to cause nervous system dysfunction occur in liver failure, and many factors contribute to malnutrition in hepatic failure. Among them are inadequate dietary intake, malabsorption, increased protein losses, hypermetabolism, insulin resistance, gastrointestinal bleeding, ascites, inflammation/infection, and hyponatremia. Patients at risk of malnutrition are relatively difficult to identify since liver disease may interfere with biomarkers of malnutrition. The supplementation of the diet with amino acids, antioxidants, vitamins as well as probiotics in addition to meeting energy and protein requirements may improve nutritional status, liver function, and hepatic encephalopathy in patients with end-stage liver failure.

Rat liver arginase system under acetaminophen-induced toxic injury and protein deprivation

“…Quite often a restriction in exogenous proteins supply is accompanied by the deficiency of essential amino acids in the organism and intensified hydrolysis of the endogenous proteins, resulting in the negative nitrogen balance and subsequent development of acute or chronic inflammatory processes in the liver [3][4][5].…”

Importance of malnutrition in patients with cirrhosis

“…Malnutrition in patients with chronic liver disease results from a variable combination of inadequate intake, poor quality diet, maldigestion, malabsorption, altered macronutrient metabolism, and hypermetabolic state (6,7). These are summarized in Table 1.…”

“…However, carbohydrate restriction is not recommended for patients with cirrhosis, and they are advised to have frequent small meals and snacks to reduce the risk of hypoglycemia. Guidelines of ESPEN recommend that carbohydrates account for 45%-65% of the total daily calories, the same as for healthy adults (8,19 (3,6).…”

“…As liver function deteriorates, more portosystemic shunts develop, causing nutrients to bypass the liver without metabolic processing. Portal hypertensive gastropathy and enteropathy, medications that affect intestinal flora (e.g., antibiotics and nonabsorbable disaccharides), and pancreatic insufficiency (particularly in alcoholic liver disease) also lead to malabsorption by different mechanisms (6,9). …”

“…Several studies have demonstrated improvement of HE symptoms with synbiotic and probiotic treatment, and some have demonstrated improvement in liver function as well. If side effects occur with the use of probiotics or synbiotics, they tend to be mild, leading to their increased use in clinical practice in an effort to manage HE and reduce infections (6,29).…”