Role of Nutrition in the Management of Hepatic Encephalopathy in End-Stage Liver Failure

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.

Frailty in advanced liver disease

“…Therefore, nutritional supplementation is recommended in cirrhosis and ideally this should be guided by indirect calorimetric measurements of energy expenditure . If calorimetry is not available, general targets for maintenance or improvement of nutritional status are total energy intake of 147‐168 kJ/kg/d and protein intake 1.2‐1.5 g/kg/d Cirrhosis can create a hyperdynamic circulation due to splanchnic vasodilatation, resulting in an increased cardiac workload and energy demand . Therefore, nutritional goals may be even higher in these hypermetabolic patients and in the postoperative setting due to increased protein catabolism .…”

Nutrition in the Management of Cirrhosis and its Neurological Complications

“…111 The impact of nutritional status on neurological complications following liver transplantation has recently been reviewed. 10 Neurological complications post-liver transplantation are legion and include diffuse encephalopathy, seizures, intracranial hemorrhage and stroke, postoperative metabolic encephalopathy, fatal progressive neurological deterioration, peripheral nerve damage, central pontine myelinolysis, cerebral abscess, ataxia, nonencephalopathic psychosis and confabulation. [112][113][114] The incidence of these complications is generally reported to be in the 25-75% range.…”

Hepatic Encephalopathy and Nutrition Influences: A Narrative Review

“…As shown in Figure , the most common reasons for this problem include decreased food intake and metabolic changes involving constant consumption of muscle proteins as the energy source. These metabolic changes are described in more detail in Table . The protein‐energy malnutrition in patients with advanced cirrhosis leads to hyperglucagonemic states, exacerbating the anorexia/cachexia viscous cycle .…”