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Nutritional Assessment of Hepatic Encephalopathy in Patients With Cirrhosis

Malnutrition and hepatic encephalopathy(HE) are two of the most common complications of cirrhosis and both have detrimental effects on outcome. Muscle tissue plays an important role in the removal of circulating ammonia; thus, loss of skeletal mass may further confound neuropsychiatric status. Nitrogen metabolism also plays a major role in the development of hepatic encephalopathy in patients with cirrhosis. Modulation of this relationship is key to the management of hepatic encephalopathy.

It follows that optimizing nutritional status, for example, by altering substrate availability, use of special substrates, or manipulation of metabolic regulation, could perhaps help prevent the development of HE. However, any dietary manipulations designed to optimize patients' cognitive function can only be applied safely if the dietary requirements dictated by their "cirrhotic status" are also taken into account.

Nutritional Assessment

Accurate assessments of nutritional status are not easily obtained in patients with cirrhosis. Ideally, therefore, a global schema should incorporate both subjective and objective variables.

Hand-grip. dynamometry provides a functional assessment of muscle strength in patients with cirrhosis, it is a sensitive and specific marker for depletion of body cell mass, and positively correlated with total body protein stores. Prevalence of malnutrition assessed using hand-grip strength is consistently higher than that obtained with other bed-side techniques. However, although there is a significant relationship between hand-grip strength and nutritional status in men, with loss of strength having a detrimental effect for survival, no such relationship exits in women.

Recent interest has focused on the use of imaging techniques, such as cross-sectional CT and magnetic resonance imaging (MRI), for assessing core skeletal muscle mass. In addition, little or no information is available on the relationships between central sarcopenia on imaging and clinical or research methods for assessing nutritional status other than body mass index (BMI) and Subjective Global Assessment (SGA), which correlate poorly, more easily applicable measures of muscle mass, such as ultrasound, functional measures of muscle strength, such as hand-grip dynamometry, or health-related quality of life . In addition, the prevalence of sarcopenia is significantly higher in men than in women.

More accurate body-composition data can be obtained by use of multicomponent models that integrate measurements from a number of techniques,such as densitometry, isotopic dilution, DXA, and in vivo neutron activation analysis. The technique of SGA utilizes clinical information and physical observation to determine nutritional status, but without recourse to objective measurements. However, this technique consistently underestimates the prevalence of malnutrition in this population.

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  • Liver dysfunction
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I was infected with hepatitis C and then it developed to liver cirrhosis.I started to take YHK in 2006, after one week, my ALT and AST values began to decrease. In Dec, I stopped the injection treatment.YHK help me a lot..
I’m a liver cirrhosis patient. I was hospitalized three times within three years and the doctor told me that the prognosis was bad.Then my friend strongly recommended me to take YHK. After taking YHK, my liver function turned better, and the jaundice disappeared as well.
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