The Nutritional Management of Hepatic Encephalopathy in Patients With Cirrhosis: International Society for Hepatic Encephalopathy and Nitrogen Metabolism Consensus

被引：372

作者：

Amodio, Piero ^{[1
]}

Bemeur, Chantal ^{[2
]}

Butterworth, Roger ^{[3
]}

Cordoba, Juan ^{[4
]}

Kato, Akinobu ^{[5
]}

Montagnese, Sara ^{[1
]}

Uribe, Misael ^{[6
,7
]}

Vilstrup, Hendrik ^{[8
]}

Morgan, Marsha Y. ^{[9
]}

机构：

[1] Univ Hosp Padua, Dept Med, I-35128 Padua, Italy

[2] Univ Montreal, Dept Nutr, Montreal, PQ H3C 3J7, Canada

[3] Ctr Hosp Univ Montreal, Neurosci Res Unit, Montreal, PQ, Canada

[4] Univ Autonoma Barcelona, Hosp Vall Hebron, Liver Unit, E-08193 Barcelona, Spain

[5] Iwate Med Univ, Dept Internal Med, Div Gastroenterol & Hepatol, Morioka, Iwate 020, Japan

[6] Univ Nacl Autonoma Mexico, Natl Inst Nutr, Mexico City, DF, Mexico

[7] Univ Nacl Autonoma Mexico, Med Sur Clin & Fdn, Mexico City, DF, Mexico

[8] Aarhus Univ Hospitral, Dept Med 5, Aarhus, Denmark

[9] UCL, Sch Med, Dept Med, UCL Inst Liver & Digest Hlth, London W1N 8AA, England

来源：

HEPATOLOGY | 2013年 / 58卷 / 01期

关键词：

SUBJECTIVE GLOBAL ASSESSMENT; CHAIN AMINO-ACIDS; BODY-COMPOSITION; LIVER-CIRRHOSIS; FRUCTO-OLIGOSACCHARIDE; ENERGY-EXPENDITURE; PROTEIN-METABOLISM; ESPEN GUIDELINES; STABLE PATIENTS; DOUBLE-BLIND;

D O I：

10.1002/hep.26370

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

100201 [内科学];

摘要：

Nitrogen metabolism plays a major role in the development of hepatic encephalopathy (HE) in patients with cirrhosis. Modulation of this relationship is key to the management of HE, but is not the only nutritional issue that needs to be addressed. The assessment of nutritional status in patients with cirrhosis is problematic. In addition, there are significant sex-related differences in body composition and in the characteristics of tissue loss, which limit the usefulness of techniques based on measures of muscle mass and function in women. Techniques that combine subjective and objective variables provide reasonably accurate information and are recommended. Energy and nitrogen requirements in patients with HE are unlikely to differ substantially from those recommended in patients with cirrhosis per se viz. 35-45 kcal/g and 1.2-1.5g/kg protein daily. Small meals evenly distributed throughout the day and a late-night snack of complex carbohydrates will help minimize protein utilization. Compliance is, however, likely to be a problem. Diets rich in vegetables and dairy protein may be beneficial and are therefore recommended, but tolerance varies considerably in relation to the nature of the staple diet. Branched chain amino acid supplements may be of value in the occasional patient intolerant of dietary protein. Increasing dietary fiber may be of value, but the utility of probiotics is, as yet, unclear. Short-term multivitamin supplementation should be considered in patients admitted with decompensated cirrhosis. Hyponatremia may worsen HE; it should be prevented as far as possible and should always be corrected slowly. Conclusion: Effective management of these patients requires an integrated multidimensional approach. However, further research is needed to fill the gaps in the current evidence base to optimize the nutritional management of patients with cirrhosis and HE.

引用

页码：325 / 336

页数：12

共 109 条

[1]

Secondary Prophylaxis of Hepatic Encephalopathy in Cirrhosis: An Open-Label, Randomized Controlled Trial of Lactulose, Probiotics, and No Therapy [J].