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Extended 78% Hepatectomy in a Mouse Surgical Model

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Nutritional support for liver disease.

Ronald L Koretz¹, Alison Avenell, Timothy O Lipman

¹Granada Hills, CA, USA. rkoretz@msn.com.

The Cochrane Database of Systematic Reviews

|May 18, 2012

Summary

Nutritional support like parenteral nutrition, enteral nutrition, or oral supplements shows limited benefits for liver disease patients. More high-quality trials are needed to confirm any potential advantages and assess risks.

Area of Science:

Hepatology
Clinical Nutrition
Evidence-Based Medicine

Background:

Weight loss and muscle wasting are prevalent in end-stage liver disease, often leading to malnutrition.
Malnutrition in liver disease is linked to poorer clinical outcomes.
Nutritional interventions (parenteral, enteral, oral) are used but require evidence of efficacy and safety.

Purpose of the Study:

To evaluate the benefits and harms of parenteral nutrition, enteral nutrition, and oral nutritional supplements in patients with liver disease.
To assess the impact of these interventions on mortality and morbidity.

Main Methods:

Systematic review and meta-analysis of randomized clinical trials.
Searched multiple databases (Cochrane, MEDLINE, EMBASE) and trial registries.

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Included trials comparing nutritional support with no support in liver disease patients.

Main Results:

Most analyses showed no significant differences in outcomes.
Parenteral nutrition showed potential benefits in reducing serum bilirubin and postoperative ascites in specific patient groups.
Oral supplements may reduce ascites and infections and improve hepatic encephalopathy in medical patients, but one trial indicated increased mortality risk.

Conclusions:

Current data do not strongly support routine use of these nutritional interventions in liver disease.
High risk of bias in most included trials casts doubt on demonstrated benefits.
Well-designed, adequately powered randomized trials with untreated control groups are necessary to establish efficacy and safety.