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Evidence summaries

Nutritional Support for Liver Disease - Parenteral Nutrition for Alcoholic Liver Disease

In patients hospitalized for alcoholic liver disease, parenteral nutrition may result in larger reduction of serum bilirubin. It might possibly reduce mortality, ascites and hepatic encephalopathy, but the evidence is insufficient for conclusions. Level of evidence: "C"

The quality of evidence is downgraded by study limitations (failure to adhere to the intention-to-treat principle and lack of blinding).

Summary

A Cochrane review [Abstract] 1 included 37 trials to assess the beneficial and harmful effects of parenteral nutrition, enteral nutrition, and oral nutritional supplements on the mortality and morbidity of patients with underlying liver disease. Results of 4 trials with a total of 170 subjects, which assessed the effects of parenteral nutrition in patients hospitalized for alcoholic liver disease, are summarized here.

When data were combined, parenteral nutrition had no demonstrable effect on mortality compared to no parenteral nutrition (RR 0.67, 95% CI 0.28 to 1.28, 4 trials). No effect was observed with regard to the appearance (RR 0.23, 95% CI 0.01 to 3.97, 2 trials) or resolution of ascites (RR 0.71, 95% CI 0.48 to 1.05, 3 trials). No effect was demonstrated on the appearance or resolution of hepatic encephalopathy; all trials employed standard amino acid formulations (RR 0.38, 95% CI 0.10 to 1.48, 3 trials). Parenteral nutrition was associated with a larger reduction in the serum bilirubin (MD -2.86 mg%, 95% CI -3.82 mg% to -1.89 mg%, 3 trials).

None of the trials reported data for gastrointestinal bleeding. No comparable data were available concerning the occurrence of similar complications in the control groups.

Clinical comments

Note

Date of latest search:

    References

    • Koretz RL, Avenell A, Lipman TO. Nutritional support for liver disease. Cochrane Database Syst Rev 2012;5:CD008344. [PubMed]

Primary/Secondary Keywords