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Review Article Nutrition and Management of Hepatic Encephalopathy
Jin-Woo Lee
Journal of Liver Cancer 2012;12(2):120-127
Published online: September 30, 2012
Department of Internal Medicine, Division of Gastroenterology and Hepatology, Inha University School of Medicine, Incheon, Korea
Corresponding author:  Jin-Woo Lee,
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It has been estimated that at least 25% of patients with liver cirrhosis experience hepatic encephalopathy during the natural history of the disease. Hepatic encephalopathy is more frequent in patients with more severe liver disease. Also, malnutrition is common in patients with liver cirrhosis, and is considered a significant prognostic factor affecting quality of life, outcome, and survival. Inadequate intake of nutrients, the hypermetabolic state, the diminished synthetic capacity of the liver and the impaired absorption of nutrients are themain reasons that disrupt the metabolic balance in cirrhosis. In the general approach to cirrhotic patients, the initial and most important step for the clinician is to recognize the extent of malnutrition. Unfortunately, the Child-Pugh-Turcotte classification and the model for end-stage liver disease (MELD) do not include an assessment of nutritional status in spite of the fact that malnutrition plays an important role in morbidity and mortality in end-stage liver failure. To date, the practice of dietary protein restriction for patients with liver cirrhosis is deeply embedded among medical practitioners and dietitians. However, the negative effects of protein restriction are clear, that is, increased protein catabolism, the release of amino acids from the muscle, and possible worsening of hepatic encephalopathy. Nutritional support with sufficient protein requirements, antioxidants, vitamins as well as probiotics may improve nutritional status, liver function, and hepatic encephalopathy in patients with liver cirrhosis.

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JLC : Journal of Liver Cancer