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Dietary management of hepatic encephalopathy revisited

Amodio, Piero; Canesso, Fabio; Montagnese, Sara

Current Opinion in Clinical Nutrition & Metabolic Care: September 2014 - Volume 17 - Issue 5 - p 448–452
doi: 10.1097/MCO.0000000000000084
NUTRITION AND THE GASTROINTESTINAL TRACT: Edited by M. Isabel T.D. Correia and Alastair Forbes

Purpose of review The burden of hepatic encephalopathy on health services is increasing, and some degree of consensus in relation to drug therapy and prophylaxis has been reached. This review focuses on the role of nutritional interventions in the management of hepatic encephalopathy.

Recent findings A number of relatively new pieces of evidence are emerging in relation to nutrition and hepatic encephalopathy as follows: first, reduction of protein intake is not useful for hepatic encephalopathy, but protein selection should be considered; second, oral supplementation with branched chain amino acids has a role not only for its nutritional effect in cirrhosis per se, but also for its effect in reducing the risk of recurrence of hepatic encephalopathy; third, alterations in gut microbiota develop in parallel with decompensation of cirrhosis, and modulation of gut microbiota may be effective for treating and preventing hepatic encephalopathy; fourth, prebiotics and probiotics are potentially useful in this aim, thus further research or trials on prebiotics and probiotics are required; fifth, micronutrient deficiency, which is common in end-stage liver disease, has adverse effects on the brain and may either directly cause encephalopathy per se, or interact with the mechanisms leading to hepatic encephalopathy.

Summary Properly performed nutritional interventions are likely to be useful for patients with hepatic encephalopathy, but well conducted clinical trials are required.

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Department of Medicine – DIMED, University of Padova, Padova, Italy

Correspondence to Piero Amodio, MD, University of Padova, Via Giustiniani, 2; 35128 Padova, Italy. Tel: +39 0498218677; fax: +39 0497960903; e-mail:

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