Individuals with chronic liver disease have altered nutrient absorption, metabolism and utilization. One of the primary goals of nutritional intervention for chronic liver disease is to prevent or correct the disease related malnutrition without contributing to the risk of encephalopathy.
In end stage liver disease, a plasma amino acid imbalance exists in which branched chain amino acids (BCAA) are decreased and aromatic amino acids (AAA) plus methionine are increased. Litifi et al have shown that the BCAAs furnish as much as 30% of energy requirements for skeletal muscle, heart and brain which accounts for the decrease in serum BCAA levels. At the same time, AAAs and methionine are released into circulation from the breakdown of muscle. However, liver clearance of AAAs is depressed and plasma levels of AAAs subsequently increase. This imbalance of plasma amino acids may contribute to the development of hepatic encephalopathy by the AAAs limiting the cerebral uptake of BCAAs.
Chronic liver disease.
- High in branched-chain amino acids (46% of protein as BCAAs)
- Low in aromatic amino acids and methionine (2% of protein as AAAs)
- High calorie to nitrogen ratio for protein sparing with 57% of calories from simple carbohydrates and only 28% of calories from fat to facilitate nutrient utilization.
- NPC:N Ratio=150:1
- Calorically dense and sodium free for fluid management (1.43 cal/mL)
- Vitamin and mineral free to allow for greater patient acceptance.