ESPEN GUIDELINESESPEN Guidelines on Enteral Nutrition: Liver disease☆
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
References (56)
- et al.
VA cooperative study on alcoholic hepatitis. II: prognostic significance of protein-calorie malnutrition
Am J Clin Nutr
(1986) - et al.
Controlled trial of nutritional supplementation, with and without branched chain amino acid enrichment, in treatment of acute alcoholic hepatitis
J Hepatol
(1985) - et al.
Short- and long-term outcome of severe alcohol-induced hepatitis treated with steroids or enteral nutrition: a multicenter randomized trial
Hepatology
(2000) - et al.
Accelerated improvement of alcoholic liver disease with enteral nutrition
Gastroenterology
(1992) - et al.
Malnutrition in alcoholic and virus-related cirrhosis
Am J Clin Nutr
(1996) - et al.
Nutrition and survival in patients with liver cirrhosis
Nutrition
(2001) - et al.
Does malnutrition affect survival in cirrhosis? PINC (Policentrica Italiana Nutrizione Cirrosi)
Hepatology
(1996) - et al.
Clinical significance and correlates of whole body potassium status in patients with liver cirrhosis
Hepatol Res
(1999) - et al.
Utility of standard nutritional parameters in detecting body cell mass depletion in patients with end-stage liver disease
Liver Transplant
(2000) - et al.
ESPEN guidelines for nutrition in liver disease and transplantation
Clin Nutr
(1997)
Early detection of protein depletion in alcoholic cirrhosis: role of body composition analysis
Gastroenterology
The creatinine approach to estimate skeletal muscle mass in patients with cirrhosis
Hepatology
Bioelectrical impedance analysis is a useful bedside technique to assess malnutrition in cirrhotic patients with and without ascites
Hepatology
Whole-body and segmental bioelectrical parameters in chronic liver disease: effect of gender and disease stages
Hepatology
Enteral hyperalimentation in undernourished patients with cirrhosis and ascites
Am J Clin Nutr
Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial
Gastroenterology
Effects of oral branched chain amino acid granules on event-free survival in patients with liver cirrhosis
Clin Gastroenterol Hepatol
Energy and protein requirements of patients with chronic liver disease
J Hepatol
Normal protein for episodic hepatic encephalopathy: results of a randomized trial
J Hepatol
Effects of ascites resolution after successful TIPS on nutrition in cirrhotic patients with refractory ascites
Am J Gastroenterol
Weight gain after TIPS is associated with improvement in body composition in malnourished patients with cirrhosis and hypermetabolism
J Hepatol
Resting energy expenditure and nutritional state in patients with liver cirrhosis before and after liver transplantation
Clin Nutr
Nutritional support in children with end-stage liver disease: a randomized crossover trial of a branched-chain amino acid supplement
Am J Clin Nutr
Comparison of enteral feeding and total parenteral nutrition after liver transplantation
Lancet
Tube jejunostomy in liver transplant recipients
Surgery
Clinical practice of nutrition in acute liver failure–a European survey
Clin Nutr
Methodology for the development of the ESPEN Guidelines on Enteral Nutrition
Clin Nutr
Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, Definitions and General Topics
Clin Nutr
Cited by (555)
Nutritional education strategies for patients with cirrhosis: A narrative review
2023, Patient Education and CounselingNutrition in liver disease
2023, Comprehensive Guide to Hepatitis AdvancesPredicted estimates of resting energy expenditure have limited clinical utility in patients with cirrhosis
2022, Journal of HepatologyModulation of tube feeding protocol to prevent aspiration pneumonia in gastroesophageal reflux
2022, Clinical Nutrition Open Science
- ☆
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.