Nutritional Pharmacotherapy of Liver Cirrhosis for Prognosis and Improvement of Quality of Life

Abstract

Patients with liver cirrhosis are in a state of protein and energy malnutrition (PEM), and this can lead to patients' poor prognosis and quality of life. Metabolic abnormalities such as hypermetabolism or decreased glucose level and increased fat oxidation, as measured by indirect calorimetry, might trigger and/or worsen PEM. Supplementation with branched-chain amino acids (BCAA) improves hepatic encephalopathy and protein malnutrition (e.g., increasing the serum albumin level and improving the nitrogen balance), and subsequently improves patients' prognosis and quality of life. Late evening snack (LES) shortens the starvation period during the night in cirrhosis. Decreased respiratory quotient, suggesting patients' poor prognosis, was recovered to almost normal by LES. This might help to prevent the reduction of muscle volume and fat tissue, improving energy malnutrition in cirrhosis. Preservation of muscle volume is a critical issue for the patients whose muscle strength is weakened, which contributes to poor quality of life. In future studies, the mechanism of the clinical effects of BCAA and LES should be elucidated for the improvement of PEM in patients with cirrhosis.