Nutritional assessment in cirrhotic patients with hepatic encephalopathy

Table 1 Possible causes of malnutrition in patients with cirrhosis and hepatic encephalopathy

Possible causes	Clinical manifestation
Reduced ingestion of foods	Anorexia
	Early satiety
	Ascites
	Confusion and/or excessive somnolence
	Frequent hospitalizations
Impaired absorption of	Alterations in enterohepatic circulation
nutrients	Impaired biliary excretion
	Small intestinal bacterial overgrowth
	Portosystemic shunts
Metabolic disturbances	Protein hypercatabolism/BCAA depletion
	Decreased glycogen stores and gluconeogenesis
	Insulin resistance and enhanced ketogenesis
	Increased lipolysis and fatty acid oxidation
Other factors	Restricted diets (e.g., low sodium diets)
	Protein loss during large volume paracentesis
	Abdominal distention during lactulose therapy

BCAA: Branched chain amino acids.