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Nutrition Aspects of Liver Failure

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Nutrition and Gastrointestinal Disease

Part of the book series: Clinical Gastroenterology ((CG))

Summary

Because the liver performs hundreds of metabolic functions, nutritional status and nutrient metabolism are altered in individuals with liver disease. This chapter reviews relationships between nutritional status and liver disease, describes effects of malnutrition and nutrition support on outcomes, and defines nutrition therapies for patients with liver disease.

Objective nutrition assessment parameters are often confounded by symptoms of liver disease; therefore, subject global assessment criteria are often applied. The degree of malnutrition is influenced by the type and severity of liver disease. The cause of malnutrition is multifactorial including diet inadequacy, malabsorption, gastrointestinal symptoms and altered nutrient metabolism.

Nutrition supplementation (through oral, tube feeding or parenteral routes) can be used to supply macro- and micronutrients to patients at nutritional risk. Protein should not be restricted for patients with liver disease. Calories, electrolytes, fluid, vitamins and minerals should be individualized for each patient taking into consideration his/her nutritional status, type and stage of liver disease, and medical treatments. There is not strong evidence to support the use of herbal supplements in individuals with liver failure.

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References

  1. Action plan for liver disease research. Rockville, MD: US Department of Health and Human Services, National Institutes of Health; 2004. NIH Publication 04-9451. Available at: http://www.niddk.nih.gov/fund/divisions /ddn/ldrb/ldrb_action_plan.htm. Accessed 4 February 2006.

    Google Scholar 

  2. Stickel F, Hoehn B, Schuppan D, et al. Review article: nutritional therapy in alcoholic liver disease. Aliment Pharmacol Ther 2003;18:357–373.

    Article  PubMed  CAS  Google Scholar 

  3. Müller MJ. Hepatic energy and substrate metabolism: a possible metabolic basis for early nutritional support in cirrhotic patients. Nutrition 1998;14:30–38.

    Article  PubMed  Google Scholar 

  4. Alvares-da-Silva MR, da Silveira TR. Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition 2005;21:1133–1117.

    Article  Google Scholar 

  5. Figueiredo FA, Dickson ER, Pasha TM, et al. Utility of standard nutritional parameters in detecting body cell mass depletion in patients with end-stage liver disease. Liver Transplant 2000;6:575–581.

    Article  CAS  Google Scholar 

  6. DiCecco SR, Wieners EJ, Wiesner RH, et al. Assessment of nutritional status of patients with end-stage liver disease undergoing liver transplantation. Mayo Clin Proc 1989;64:95–102.

    PubMed  CAS  Google Scholar 

  7. Zaina FE, Parolin MB, Lopes RW, et al. Prevalence of malnutrition in liver transplant candidates. Transplant Proc 2004;36:923–925.

    Article  PubMed  CAS  Google Scholar 

  8. Figueiredo FAF, Perez RDM, Kondo M. Effect of liver cirrhosis on body composition: evidence of significant depletion even in mild disease. J Gastoenterol Hepatol 2005;20:209–216.

    Article  Google Scholar 

  9. Müller M, Lautz H, Plogmann B, et al. Energy expenditure and substrate oxidation in patients with cirrhosis: the impact of cause, clinical staging, and nutritional state. Hepatology 1992;15:782–794.

    Article  PubMed  Google Scholar 

  10. Roongpisuthipong C, Sobhonslidsuk A, Nantiruj K, et al. Nutritional assessment in various stages of liver cirrhosis. Nutrition 2001;17:761–765.

    Article  PubMed  CAS  Google Scholar 

  11. Campillo B, Richardet J-P, Scherman E, et al. Evaluation of nutritional practice in hospitalized cirrhotic patients: results of a prospective study. Nutrition 2003;19:515–521.

    Article  PubMed  Google Scholar 

  12. Alberino F, Gatta A, Amodio P, et al. Nutrition and survival in patients with liver cirrhosis. Nutrition 2001;17:445–450.

    Article  PubMed  CAS  Google Scholar 

  13. MuCullough AJ. Malnutrition in liver disease. Liver Transplant 2000;6 (Suppl 1):S86–S96.

    Google Scholar 

  14. Riggio O, Angeloni S, Ciuffa L, et al. Malnutrition is not related to alterations in energy balance in patients with stable liver cirrhosis. Clin Nutr 2003;22:553–559.

    Article  PubMed  CAS  Google Scholar 

  15. Allard JP, Chau J, Sandokji K, et al. Effects of ascites resolution after successful TIPS on nutrition in cirrhotic patients with refractory ascites. Am J Gastroenterol 2001;96:2442–2447.

    Article  PubMed  CAS  Google Scholar 

  16. Santolaria F, Perez-Manzano JL, Milena A, et al. Nutritional assessment in alcoholic patients. Its relationship with alcoholic intake, feeding habits, organic complications and social problems. Drug Alcohol Depend 2000;59:295–304.

    Article  PubMed  CAS  Google Scholar 

  17. Plauth M, Schütz T, Buckendahl DP, et al. Weight gain after transjugular intrahepatic protosystemic shunt is associated with improvement in body composition in malnourished patients with cirrhosis and hypermetabolism. J Hepatol 2004;40:228–233.

    Article  PubMed  Google Scholar 

  18. Falck-Yttr Y, Younossi ZM, Marchesini G, et al. Clinical features and natural history of nonalcoholic steatosis syndromes. Semin Liver Dis 2001;21:17–26.

    Article  Google Scholar 

  19. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002;346:1221–1231.

    Article  PubMed  CAS  Google Scholar 

  20. Clark JM, Brancati FL, Diehl AM. Nonalcoholic fatty liver disease. Gastroenterol 2002;122:1649–1657.

    Article  Google Scholar 

  21. Marchesini G, Bugianesis E, Forlani G, et al. Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology 2003;37:917–923.

    Article  PubMed  Google Scholar 

  22. Pagano G, Pacini G, Musso G, et al. Nonalcoholic steatohepatitis, insulin resistance, and metabolic syndrome: further evidence for an etiologic association. Hepatology 2002;35:367–372.

    Article  PubMed  CAS  Google Scholar 

  23. Musso G, Gambino R, De Michieli F, et al. Dietary habits and their relations to insulin resistance and postprandial lipemia in nonalcoholic steatohepatitis. Hepatology 2003;37:909–916.

    Article  PubMed  CAS  Google Scholar 

  24. Lautz HU, Selberg O, Körber J, et al. Protein calorie malnutrition in liver cirrhosis. Clin Invest 1992;70:478–486.

    Article  CAS  Google Scholar 

  25. Merli M, Riggio O, Dally L et al. Does malnutrition affect survival in cirrhosis? Hepatology 1996;23:1041–1046.

    Article  PubMed  CAS  Google Scholar 

  26. Cunha L, Happi Nono M, et al. Effects of prolonged oral nutritional support in malnourished cirrhotic patients: results of a pilot study. Gastroenterol Clin Biol 2004;28:36–39.

    Article  PubMed  Google Scholar 

  27. Le Cornu KA, McKiernan FJ, Kapadia SA, et al. A prospective randomized study of preoperative nutritional supplementation in patients awaiting elective orthotopic liver transplantation. Transplantation 2000;69:1354–1369.

    Article  Google Scholar 

  28. Hasse JM, Crippin JS, Blue LS, et al. Branched-chain amino acid-enriched nutrition supplementation reduces hospitalization in malnourished patients with a history of encephalopathy awaiting liver transplantation. [Abstract]. JPEN J Parenter Enteral Nutr 1997;21:S16.

    Article  Google Scholar 

  29. Plank LD, McCall JL, Gane EJ, et al. Pre- and postoperative immunonutrition in patients ndergoing liver transplantation: a pilot study of safety and efficacy. Clin Nutr 2005;24:288–296.

    Article  PubMed  Google Scholar 

  30. de Ledinghen V, Beau P, Mannant PR, et al. Early feeding or enteral nutrition in patients with cirrhosis after bleeding from esophageal varices? A randomized controlled study. Dig Dis Sci 1997;42:536–541.

    Article  PubMed  Google Scholar 

  31. Merli M, Riggio O, Romiti A, et al. Basal energy production rate and substrate use in stable cirrhotic patients. Hepatology 1990;12:106–112.

    Article  PubMed  CAS  Google Scholar 

  32. Müller MJ, Böttcher J, Selberg O, et al. Hypermetabolism in clinically stable patients with liver cirrhosis. Am J Clin Nutr 1999;69:1194–1201.

    PubMed  Google Scholar 

  33. Kondrup J, Müller MJ. Energy and protein requirements of patients with chronic liver disease. J Hepatol 1997;27:239–247.

    Article  PubMed  CAS  Google Scholar 

  34. Schneeweiss B, Graninger W, Ferenci P, et al. Energy metabolism in patients with acute and chronic liver disease. Hepatology 1990;11:387–393.

    Article  PubMed  CAS  Google Scholar 

  35. Greco AV, Mingrone G, Benedetti G, et al. Daily energy and substrate metabolism in patients with cirrhosis. Hepatology 1998;27: 346–350.

    Article  PubMed  CAS  Google Scholar 

  36. Madden AM, Morgan MY. Resting energy expenditure should be measured in patients with cirrhosis, not predicted. Hepatology 1999;30:655–664.

    Article  PubMed  CAS  Google Scholar 

  37. Weisiger RA. Hepatic metabolism in liver disease. In : Goldman L, Bennett JC (eds) Cecil textbook of medicine, 21st edn. Philadelphia: WB Saunders. 2000;768–770.

    Google Scholar 

  38. Dichi I, Dichi JB, Papini-Berto SJ, et al. Protein-energy status and 15N-glycine kinetic study of Child A cirrhotic patients fed low-to high-protein energy diets. Nutrition 1996;12:519–523.

    Article  PubMed  CAS  Google Scholar 

  39. Dichi JB, Dichi I, Maio R, et al. Whole-body protein turnover in malnourished patients with Child class B and C cirrhosis on diets low to high in protein energy. Nutrition 2001;17:239–242.

    Article  PubMed  CAS  Google Scholar 

  40. Nielsen K Nielsen K, Kondrup J, et al. Long-term oral refeeding of patients with cirrhosis of the liver. Br J Nutr 1995;74:557–567.

    Article  PubMed  CAS  Google Scholar 

  41. Cordoba J, Lopez-Hellin J, Planas M, et al. Normal protein diet for episodic hepatic encephalopathy: results of a randomized study. J Hepatol 2004;41:38–43.

    Article  PubMed  CAS  Google Scholar 

  42. Marchesini G, Bianchi G, Merli M, et al; Italian BCAA Study Group. Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial. Gastroenterology 2003;124:1792–1801.

    Article  PubMed  CAS  Google Scholar 

  43. Als-Nielsen B, Koretz RL, Kjaergard LL, et al. Branched-chain amino acids for hepatic encephalopathy, The Cochrane Database of Systematic Reviews. Issue 1. Art No.: CD001939. DOI: 10.1002/14651858.CD001939, 2003.

    Google Scholar 

  44. Hasse JM, Matarese LE. Medical nutrition therapy for liver biliary system, and exocrine pancreas disorders. In: Mahan LK, Escott-Stump S (eds) Krause’s food, nutrition, and diet therapy, 11th edn. Philadelphia: W.B. Saunders Company 2004:738–767.

    Google Scholar 

  45. Loguercio C, DeGirolamo B, Federico A, et al. Relationship of blood trace elements to liver damage, nutritional status, and oxidative stress in chronic nonalcoholic liver disease. Biol Trace Elem Res 2001;81:245–254.

    Article  PubMed  CAS  Google Scholar 

  46. Solga SF. Probiotics can treat hepatic encephalopathy. Med Hypotheses 2003;61:307–313.

    Article  PubMed  CAS  Google Scholar 

  47. Jacobs BP, Dennehy C, Ramirez G, Sapp J, et al. Milk thistle for the treatment of liver disease: a systematic review and meta-analysis. Am J Med 2002;113:506–515.

    Article  PubMed  Google Scholar 

  48. Rambaldi A, Gluud C. S-adenosyl-L-methionine for alcoholic liver diseases. The Cochrane Database of Systematic Reviews. Issue 4: Art. No.: CD002235. DOI: 10.1002/14651858.CD002235, 2001.

    Google Scholar 

  49. Rambaldi A, Jacobs BP, Iaquinto G, et al. Milk thistle for alcoholic and/or hepatitis B or C virus liver disease. The Cochrane Database of Systematic Reviews. Issue 2: Art. No.: CD003620.pub2. DOI: 10.1002/14651858. CD003620.pub2.

    Google Scholar 

  50. Cabre E, Gozalez-Huix G, Abad-Lacruz A, et al. Effect of total enteral nutrition on the short-term outcome of severely malnourished cirrhotics. A randomized controlled trial. Gastroenterol 1990;98:715–720.

    CAS  Google Scholar 

  51. Kearns PJ, Young H, Garcia G, et al. Accelerated improvement of alcoholic liver disease with enteral nutrition. Gastroenterol 1992;102:200–205.

    CAS  Google Scholar 

  52. Soberon S, Pauley MP, Duplantier R, et al. Metabolic effects of enteral formula feeding in alcoholic hepatitis. Hepatology 1987;7:1204–1209.

    Article  PubMed  CAS  Google Scholar 

  53. Cabre E, Rodríguez-Iglesias P, Caballeria J, et al. Short- and long-term outcome of severe alcohol-induced hepatitis treated with steroids or enteral nutrition: a multicenter randomized trial. Hepatology 2000;32:36–42.

    Article  PubMed  CAS  Google Scholar 

  54. Hu Q-G, Zheng Q-C. The influence of enteral nutrition in postoperative patients with poor liver function. World J Gastroenterol 2003;9:843–846.

    PubMed  CAS  Google Scholar 

  55. Zhang K, Sun WB, Want HF, et al. Early enteral and parenteral nutritional support in patients with cirrhotic portal hypertension after pericardial devascularization. Hepatobiliary Pancreat Dis Int 2005;4:44–49.

    Google Scholar 

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Authors
  1. Jeanette M. Hasse PHD, RD, LD, FADA,CNSD
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© 2008 Humana Press Inc

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Hasse, J.M. (2008). Nutrition Aspects of Liver Failure. In: Nutrition and Gastrointestinal Disease. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-59745-320-2_4

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  • DOI: https://doi.org/10.1007/978-1-59745-320-2_4

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-58829-808-9

  • Online ISBN: 978-1-59745-320-2

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