Nutrition therapy following an overt hepatic encephalopathy (OHE) occurrence is associated with lower rates of OHE recurrence, according to study findings published in Journal of Gastroenterology & Hepatology.
Researchers recruited patients (N=150) with a history of OHE who presented at the GB Pant Hospital in India with liver cirrhosis between 2020 and 2021. Patients were randomly assigned to receive either nutritional therapy (n=75) or no therapy (n=75). The nutrition intervention comprised 30 to 35 kcal/kg/day, 1 to 1.5 g/kg/day protein supplemented with high-protein powder, and a 2 g/day salt intake restriction for 6 months with regular meetings with a dietician. The rates of OHE recurrence and hospitalization were evaluated.
The intervention and control cohorts comprised participants who were a mean age of 46.25±10.16 and 43.28±9.89 years, the male to female ratios were 62:13 and 60:15, 45.3% and 41.3% had alcohol-related cirrhosis, 12 and 11 had grade 4 OHE, and the last OHE episode occurred 94.6±52.8 and 98.4±54.6 days prior to new symptoms, respectively.
Compared with baseline, significant changes at follow-up were observed in bilirubin levels (mean, 2.33 vs 1.45 mg/dL; P <.001), Model for End-stage Liver Disease (MELD) score (mean, 19.96 vs 10.35 points; P <.001), skeletal mass index (mean, 47.01 vs 50.03 cm2/m2; P <.001), fat mass (mean, 8.37 vs 10.11 kg; P <.001), fat percentage (14.04% vs 16.79%; P <.001), interleukin (IL)-1 levels (mean, 233.17 vs 136.96 pg/mL; P <.001), and endotoxin levels (mean, 54.02 vs 38.28 EU/mL; P <.001) among the nutrition intervention recipients. Conversely, all these outcomes remained unchanged in the control arm (all P ³.05).
At 6 months significant group differences were observed for 21 outcomes (all P £.001), including bilirubin, aspartate aminotransferase, and alanine aminotransferase levels, and MELD scores.
Recurrence of OHE occurred among 13.3% of the nutrition recipients and 48.0% of the controls. Receipt of nutritional therapy associated with increased time to OHE recurrence (hazard ratio [HR], 0.20; 95% CI, 0.10-0.40; P <.001) and time to first OHE-related hospitalization (HR, 0.27; 95% CI, 0.12-0.61; P <.001).
The recurrence of OHE correlated with the change in MELD score (r, 0.362; P =0.000), Child-Turcotte Pugh score (r, 0.358; P =0.000), ammonia levels (r, 0.300; P =0.000), triceps skin fold thickness (r, -0.262; P =.001), fat mass (r, -0.264; P =.001), fat percentage (r, -0.273; P =.001), skeletal muscle index (r, -0.290; P =0.000), hand grip strength (r, -0.307; P =0.000), and mid arm circumference (r, -0.323; P =0.000).
In the multivariate analysis, OHE recurrence was associated with no nutritional therapy (odds ratio [OR], 5.26; 95% CI, 1.03-26.94; P =.04) and baseline ammonia levels (OR, 0.94; 95% CI, 0.92-0.99; P =.02).
The results of this study may not be generalizable to individuals for alcohol-unrelated cirrhosis.
These data indicated that nutrition therapy prevented breakthrough OHE among patients with cirrhosis. Additional longer-term studies are needed to evaluate the long-term effects of nutrition therapy in cirrhosis.
The study authors conclude, “This study shows that nutrition therapy prevents breakthrough episodes of OHE in patients with cirrhosis and improves anthropometry, ammonia level, inflammatory markers and myostatin levels.”
Ahuja H, Sharma BC, Sachdeva S, et al. A double blind randomized controlled trial to assess efficacy of nutritional therapy for prevention of recurrence of hepatic encephalopathy in patients with cirrhosis. J Gastroenterol Hepatol. Published online December 27, 2022. doi:10.1111/jgh.16096