Effects of Proteins in Patients With Cirrhosis and Prior Hepatic Encephalopathy
Effects of Proteins in Patients With Cirrhosis and Prior Hepatic Encephalopathy
The purpose of this study is to compare a normal-protein diet containing branched-chain amino
 acids to a low-protein diet in patients with non-terminal cirrhosis (MELD < 25) who have
 developed an episode of hepatic encephalopathy within two months prior to inclusion.
Hepatic encephalopathy is a major complication of cirrhosis associated with poor prognosis
 and poor quality of life. Appearance of HE occurs in the setting of precipitating factors
 that increase plasma ammonia. The gastrointestinal tract is the primary source of ammonia,
 which is produced by enterocytes from glutamine and by colonic bacterial catabolism of
 nitrogenous sources, such as ingested proteins. This is the rationale for proposing
 low-protein diet as strategy to reduce ammonia production and as standard diet in patients
 with cirrhosis and hepatic encephalopathy. However, low-protein diet could cause wasting
 muscle and predispose to recurrence of hepatic encephalopathy, since muscle is an important
 site for extrahepatic ammonia removal.

 Branched-chain amino acids have shown beneficial effects on mental state of patients with
 chronic hepatic encephalopathy. The possible mechanism of action may be improvement of
 nutritional status through induction of protein synthesis. However, role of branched-chain
 amino acids in treatment and prevention of acute hepatic encephalopathy is not established.

 Administration of a normal-protein diet containing oral branched-chain amino acids may reduce
 recurrence of hepatic encephalopathy as compared to a low-protein diet.
Inclusion Criteria:

 -  Cirrhosis of the liver.

 -  Recovery from an episode of hepatic encephalopathy within two months prior to
 inclusion.

 -  Compliance with a standard diet during two weeks prior to inclusion.

 Exclusion Criteria:

 -  End-stage cirrhosis (MELD score > 25).

 -  Marked cognitive disorder (mini-mental test < 27).

 -  Non-treatable hepatocarcinoma in accordance with Milan criteria.

 -  Comorbid conditions with a life expectancy less than 6 months.

 -  Neurological conditions that difficult assessment of treatment of hepatic
 encephalopathy (dementia, encephalitis, severe depression).

 -  Diseases requiring administration of a specific diet (malabsorption, chronic diarrhea,
 chronic pancreatic insufficiency, severe obesity).

 -  No acceptation of written consent.