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Updated: Jun 11, 2026
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The Murine Choline-Deficient, Ethionine-Supplemented (CDE) Diet Model of Chronic Liver Injury
Published on: October 21, 2017
Nutrition in hepatic encephalopathy.
Rajagopal Chadalavada1, Raja Shekhar Sappati Biyyani, John Maxwell
1Division of Gastroenterology, MetroHealth Medical Center, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
Summary
Protein calorie malnutrition (PCM) in chronic liver disease (CLD) patients can be managed with appropriate protein intake. Vegetable protein diets are well-tolerated in patients with dietary protein intolerance, even with advanced cirrhosis.
Area of Science:
- Hepatology
- Clinical Nutrition
- Gastroenterology
Background:
- Protein calorie malnutrition (PCM) is a significant complication of chronic liver disease (CLD).
- Dietary protein restriction has historically contributed to PCM in CLD patients.
- PCM in CLD is linked to severe, life-threatening complications.
Purpose of the Study:
- To review the causes and management of hepatic encephalopathy (HE) and PCM in CLD.
- To examine nutritional requirements and assessment strategies for CLD patients.
- To discuss treatment options for malnutrition, including dietary protein intolerance.
Main Methods:
- Review of existing literature on HE, PCM, and nutritional management in CLD.
- Analysis of studies investigating dietary protein tolerance in cirrhotic patients.
- Examination of the role of vegetable protein-based diets and BCAA formulations.
Main Results:
- Most CLD patients tolerate normal dietary protein intake without developing hepatic encephalopathy (HE).
- Vegetable protein-based diets are well-tolerated in patients with dietary protein intolerance, including those with advanced cirrhosis.
- Oral branched-chain amino acids (BCAAs) show a limited role in managing HE.
Conclusions:
- Recognizing the extent of malnutrition is crucial for managing CLD patients.
- Optimizing HE treatment with available medications is a key management approach.
- Vegetable protein diets offer a viable alternative for patients with apparent dietary protein intolerance.
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