Diet and cognition in chronic liver disease.

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Curr Opin Gastroenterol. 2010 Oct 21. [Epub ahead of print]

Diet and cognition in chronic liver disease.

Kachaamy T, Bajaj JS.

Division of Gastroenterology, Hepatology and Nutrition, Virginia Commonwealth

University and McGuire VA Medical Center, Richmond, Virginia, USA.

Abstract

PURPOSE OF REVIEW: The spectrum of neurocognitive impairment in cirrhosis spans

a continuum of minimal hepatic encephalopathy (MHE) to overt hepatic

encephalopathy (OHE), the pathophysiology of which remains incompletely

understood. The current available evidence, however, suggests that nutrition

plays an important role in its development and points to the fact that

malnutrition increases the morbidity and mortality of patients with cirrhosis.

This review incorporates recent findings published in the last 2 years within

the evolution of evidence regarding the role dietary manipulation can play in

the comprehensive management of patients with cirrhosis and cognitive

dysfunction.

RECENT FINDINGS: In patients with cirrhosis it is important to prevent

starvation physiology which occurs after few hours of caloric deprivation as

compared to 3 days in noncirrhotics. This can be accomplished by making sure

that cirrhotic patients have daily breakfast and a late evening snack. In

addition, probiotics and symbiotics are well tolerated and improve cognitive

function in patients with MHE.

SUMMARY: The long-time held belief that protein restriction is needed to improve

encephalopathy has no scientific basis but remains widely practiced.

Branched-chain amino acids supplement may be helpful in patients who continue to

suffer from OHE despite treatment of precipitating events and pharmacologic

treatment with lactulose and rifaximin. Preventing starvation physiology and

supplementing the diet with prebiotics and symbiotics are helpful in patients

with MHE.

PMID: 20975555 [PubMed - as supplied by publisher]