Published online May 18, 2017. doi: 10.4254/wjh.v9.i14.667
Peer-review started: October 31, 2016
First decision: December 1, 2016
Revised: February 21, 2017
Accepted: April 23, 2017
Article in press: April 24, 2017
Published online: May 18, 2017
Core tip: In this study we investigated the plasma amino acid response to standard and high protein meals in patients with liver cirrhosis and looked for evidence of protein intolerance by testing for the presence of either covert or overt hepatic encephalopathy. We sought to improve on previous methodology by selecting a more homogeneous group of patients with biopsy proven cirrhosis, and by using natural mixed protein meals at two protein levels: A standard (20 g) meal and a high (1 g/kg per body weight) protein meal. We found small differences in the plasma amino acid changes after the standard protein meal but there were marked increments in most amino acids after the high protein meal. Noteworthy no patient showed overt clinical sings of encephalopathy and minor electroencephalo-graph changes were seen in only one patient after the high protein meal. These results present experimental evidence to support current nutritional guidelines for patients with cirrhosis.