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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Hepatol. Dec 28, 2015; 7(30): 2940-2954
Published online Dec 28, 2015. doi: 10.4254/wjh.v7.i30.2940
Nutritional assessment in cirrhotic patients with hepatic encephalopathy
Fernando Gomes Romeiro, Laís Augusti
Fernando Gomes Romeiro, Laís Augusti, Gastroenterology Division, Department of Internal Medicine - Botucatu Medical School, UNESP-Univ Estadual Paulista, Botucatu 18608-917, São Paulo, Brazil
Author contributions: Romeiro FG designed the study, obtained the data, drafted and corrected the final article; Augusti L obtained and organized the data, drafted and corrected the article. Both authors read and approved the final manuscript.
Supported by São Paulo Research Foundation (FAPESP), CAPES and PROPe/UNESP, Nos. 2013/15121-8 and 2013/11761-2.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Fernando Gomes Romeiro, Gastroenterology Division, Department of Internal Medicine - Botucatu Medical School, UNESP-Univ Estadual Paulista, Distrito de Rubião Jr. s/n, Botucatu 18608-917, São Paulo, Brazil. fgromeiro@fmb.unesp.br
Telephone: +55-14-38801173 Fax: +55-14-38801667
Received: April 28, 2015
Peer-review started: May 6, 2015
First decision: September 8, 2015
Revised: September 23, 2015
Accepted: December 13, 2015
Article in press: December 14, 2015
Published online: December 28, 2015
Processing time: 243 Days and 10.2 Hours
Abstract

Hepatic encephalopathy (HE) is one of the worst complications of liver disease and can be greatly influenced by nutritional status. Ammonia metabolism, inflammation and muscle wasting are relevant processes in HE pathophysiology. Malnutrition worsens the prognosis in HE, requiring early assessment of nutritional status of these patients. Body composition changes induced by liver disease and limitations superimposed by HE hamper the proper accomplishment of exams in this population, but evidence is growing that assessment of muscle mass and muscle function is mandatory due to the role of skeletal muscles in ammonia metabolism. In this review, we present the pathophysiological aspects involved in HE to support further discussion about advantages and drawbacks of some methods for evaluating the nutritional status of cirrhotic patients with HE, focusing on body composition.

Keywords: Hepatic encephalopathy; Liver cirrhosis; Malnutrition; Anthropometry; Muscle strength; Electric impedance; Nutrition assessment; Dual-energy X-ray absorptiometry

Core tip: Ammonia metabolism, inflammation and muscle wasting are relevant processes in hepatic encephalopathy (HE) pathophysiology and malnutrition worsens the prognosis in this condition, requiring early assessment of nutritional status in these patients. Body composition changes induced by liver disease and limitations superimposed by HE make difficult to accomplish exams properly in this population, but there is a growing evidence that assessment of muscle mass and muscle function is mandatory due to the role of skeletal muscles in ammonia metabolism. In this article, we review HE pathophysiology and discuss the main methods of nutritional assessment, suggesting the best approaches in HE patients.