The efficacy of parenteral nutrition (PN) and enteral nutrition (EN) supports in cirrhosis

Abstract

Importance: Multiple nutritional therapies are currently available for patients with liver cirrhosis, yet many interventions have not been compared head-to-head within randomized clinical trials. Objective: To evaluate the improvement of nutritional indicators and liver function indexes of liver cirrhosis treated with different nutrition intervention. Data source: We searched PubMed, Embase. com and Cochrane Library database from construction to April 3, 2020. After eliminating the duplicated or overlapping reports, 6 studies were included. We performed a Bayesian network meta-analysis by Stata 12.0 and GeMTC 0.14.3 in order to compare different nutritional interventions with consistency model. Study selection: Randomized clinical trials comparing 2 or more therapies in patients with cirrhosis were evaluated. Six randomized clinical trials met the selection criteria. Data extraction and synthesis: Two investigators independently reviewed the full manuscripts of eligible studies and extracted information into an electronic database: patients’ characteristics study design, interventions, the number of events of interest in each group. Main outcomes and measures: Body mass index, Child-Pugh score, model for end-stage liver disease score, total bilirubin, alanine transaminase, aspartate transaminase, total protein, Triceps skinfold, Midarm Muscle Circumference, Fischer ratio, overall survival. Results: There are 6 studies enrolling a total of 1148 patients who received different nutrition supports including parenteral nutrition (PN), enteral nutrition (EN), EN (without branched-chain amino acids), EN + intestinal probiotics, PN + EN, late evening snacks (LES), EN + LES, noLES. The direct comparisons showed that the effect of EN was better than EN (without branched-chain amino acids); EN + intestinal probiotics was better than EN and PN; PN + EN was better than them alone; EN + LES was better than LES and EN; LES was better than noLES. Although the difference of indirect comparisons between the included regimens was not statistically significant, the results showed that EN + intestinal probiotics appeared to be superior to PN + EN. While LES and EN + LES seemed to rank behind them and the difference between them was extremely small. Conclusion and relevance: Available evidence suggests that EN + intestinal probiotics appear to be the most effective strategy for patients with cirrhosis compared with other interventions.

Nutritional Support for Liver Diseases

“…In addition, supplementation with probiotics may, on the one hand, promote the growth of beneficial bacteria and, on the other hand, limit the growth of undesirable bacteria and the production of their harmful metabolites while supporting intestinal transport [ 141 , 142 ]. Based on the results of a meta-analysis and a network meta-analysis, Yu et al [ 119 ] concluded that EN+ gut probiotics may be the most effective intervention, relatively speaking. In patients with cirrhosis, antibiotic therapy is often necessary, which leads to an imbalance of the intestinal flora, which results in the generation of enterotoxins and the metabolites of pathogenic microflora [ 119 ].…”

“…Based on the results of a meta-analysis and a network meta-analysis, Yu et al [ 119 ] concluded that EN+ gut probiotics may be the most effective intervention, relatively speaking. In patients with cirrhosis, antibiotic therapy is often necessary, which leads to an imbalance of the intestinal flora, which results in the generation of enterotoxins and the metabolites of pathogenic microflora [ 119 ].…”

“…During the progression to cirrhosis, the risk of malnutrition and sarcopenia increases-Figure 2 So far, the effectiveness of various intervention therapies has been studied, which were parenteral nutrition (PN), enteral nutrition (EN), EN + intestinal probiotics, PN + EN EN (without branched-chain amino acids BCAAs), late evening snack (LES), EN + LES noLES. PN, EN, and PN+EN represent the routine therapy for cirrhosis, while EN+ intes tinal probiotics, LES, and EN + LES have been at the cutting edge of therapy in recen years [119].…”