Significant effects of late evening snack on liver functions in patients with liver cirrhosis: A meta‐analysis of randomized controlled trials

Abstract

Background and Aim Reducing post‐absorptive (fasting) phase by eating late evening snacks (LESs) is a potential intervention to improve substrate utilization and reverse sarcopenia. This study analyzed the results of published randomized controlled trials and controlled clinical trials to evaluate the effects of LES on liver function of patients with cirrhosis. Methods A meta‐analysis was conducted. The search strategy included electronic database searches, and 300 articles were searched. Eight of these articles provided qualified data for pooling and analysis. Outcomes assessments included serum albumin, total bilirubin, alanine aminotransferase, prothrombin time, and aspartate aminotransferase, complications of cirrhosis, severity of liver disease, and blood glucose levels. Results Our analysis included eight studies comprising 341 patients (167 in LES groups and 174 in control groups). The results showed that LES intervention helped to maintain liver reserves. These eight studies demonstrated that LES intervention had significant effects for liver biochemical parameters on albumin, ammonia, and prothrombin time, with respective effect sizes of 0.233, −0.425, and −0.589; liver enzymes include aspartate aminotransferase and alanine aminotransferase, with respective effect sizes of −0.320 and −0.284. Studies on clinical signs of liver dysfunction showed lower occurrence rates of ascites and hepatic encephalopathy than in the control group. LES had no significant effect on Child–Pugh score. Conclusions The overall results of the meta‐analysis indicated that having LES can improve liver function reserve for patients with liver cirrhosis, with or without hepatocellular carcinoma. LES is a promising intervention for reversing anabolic resistance and the sarcopenia of cirrhosis, resulting in an improved quality of life for patients with cirrhosis.

Review article: malnutrition/sarcopenia and frailty in patients with cirrhosis

“…It should be emphasised that the optimal daily energy intake should not be lower than 35 kcal/kg/d (in non‐obese individuals) and protein intake should not be lower than 1.2‐1.5 g/kg/d (amount of protein > 1.5 g/kg/d should be ingested to replenish malnourished and/or sarcopenic state) . The daily intake should be divided into frequent small meals and/or snack (5‐6 times/d) and, of importance, late evening oral nutritional supplementation containing ≥ 50 g of complex carbohydrates must be included, as it has been shown to be more effective on substrate utilisation and nitrogen retention than daytime calorie supplementation alone . Several studies have demonstrated that late evening snack or meal is an effective intervention to prevent and to reverse sarcopenia in cirrhosis, resulting in an improvement in quality of life and also liver functions .…”

“…1,4 The daily intake should be divided into frequent small meals and/or snack (5-6 times/d) and, of importance, late evening oral nutritional supplementation containing ≥ 50 g of complex carbohydrates must be included, as it has been shown to be more effective on substrate utilisation and nitrogen retention than daytime calorie supplementation alone. 1,4,[88][89][90] Several studies have demonstrated that late evening snack or meal is an effective intervention to prevent and to reverse sarcopenia in cirrhosis, resulting in an improvement in quality of life and also liver functions. [88][89][90] Notably, when prescribing a low sodium (<2-3 g/d) diet, the increased risk of even lower food intake (due to unpalatability) should be balanced against its moderate advantage in the treatment of ascites.…”

“…1,4,[88][89][90] Several studies have demonstrated that late evening snack or meal is an effective intervention to prevent and to reverse sarcopenia in cirrhosis, resulting in an improvement in quality of life and also liver functions. [88][89][90] Notably, when prescribing a low sodium (<2-3 g/d) diet, the increased risk of even lower food intake (due to unpalatability) should be balanced against its moderate advantage in the treatment of ascites. 4…”

Nutrition is often ignored in management of chronic liver diseases

“…In this issue, Chen et al conducted meta-analysis of eight published randomized control comprising 341 patients (167 in LES groups and 174 in control groups) and controlled clinical trials to evaluate the effects of LES on patients with cirrhosis. 4 The eight studies demonstrated that LES intervention had significant effects for liver biochemical parameters such as albumin, ammonia and prothrombin time, serum AST, and ALT. Studies on clinical signs of liver dysfunction showed lower occurrence rates of ascites and hepatic encephalopathy than in the control group.…”

“…In the present issue of the Journal of Gastroenterology and Hepatology, Chen et al . reported results of meta‐analysis of studies which investigate the effects of the late evening snack (LES) on liver function in patients with cirrhosis . Recent studies of the effect of nutritional managements for cirrhotic patents on their quality of life and life prognoses include the following.…”