Elsevier

Clinical Nutrition

Volume 25, Issue 2, April 2006, Pages 285-294
Clinical Nutrition

ESPEN GUIDELINES
ESPEN Guidelines on Enteral Nutrition: Liver disease

https://doi.org/10.1016/j.clnu.2006.01.018Get rights and content

Summary

Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility to increase or to insure nutrient intake in case of insufficient oral food intake.

The present guideline is intended to give evidence-based recommendations for the use of ONS and TF in patients with liver disease (LD). It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference.

EN by means of ONS is recommended for patients with chronic LD in whom undernutrition is very common. ONS improve nutritional status and survival in severely malnourished patients with alcoholic hepatitis. In patients with cirrhosis, TF improves nutritional status and liver function, reduces the rate of complications and prolongs survival. TF commenced early after liver transplantation can reduce complication rate and cost and is preferable to parenteral nutrition. In acute liver failure TF is feasable and used in the majority of patients.

The full version of this article is available at www.espen.org.

Section snippets

Alcoholic steatohepatitis (ASH)

Preliminary remarks: There are no randomised controlled trials available on nutritional therapy in non-alcoholic steatohepatitis (NASH). Unlike alcoholic steatohepatitis (ASH), NASH often is associated with overnutrition and insulin resistance. Therefore recommendations given for ASH cannot easily be applied to NASH despite remarkable similarities. Nutritional recommendations for NASH patients focus on the underlying disease (metabolic syndrome, other secondary causes).

1.1. Does nutritional

Liver cirrhosis (LC)

2.1. Does nutritional status influence outcome in patients with LC? What is the best widely applicable method to assess nutritional status?

Undernutrition adversely affects the prognosis in patients with LC (III).

Simple bedside methods such as the SGA or anthropometry are considered adequate to identify patients at risk (C).

In order to quantitate undernutrition the determination of phase angle α or body cell mass (BCM) using bioelectrical impedance analysis (BIA) is recommended, despite some

Transplantation and surgery

(See also guidelines “Surgery incl. Organ Transplantation”).

3.1. Does nutritional status influence outcome? Which is the best widely applicable method of assessing nutritional status?

The prognostic value of preoperative nutritional status in liver transplant patients has been demonstrated (Ib).

Simple bedside methods such as SGA or anthropometry are considered adequate to identify patients at risk (C). In order to quantitate undernutrition the determination of phase angle α or body cell mass

Fulminant liver failure

Fulminant liver failure without treatment results in death within days. Stabilisation of metabolism is mandatory and, in that phase of the disease, it is more important than nutritional therapy aimed at meeting daily requirements. Hypoglycaemia is a frequent metabolic disturbance and merits particular attention and therapy, such as (par)enteral glucose administration (C).

Patients with acute liver failure should receive EN via nasoduodenal tube (C). No recommendations concerning a disease

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    For further information on methodology see Schütz et al.55 For further information on definition of terms see Lochs et al.56

    ☆☆

    The authors of the DGEM (German Society for Nutritional Medicine) guidelines on enteral nutrition in liver disease are acknowledged for their contribution to this article.

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