Conservative Treatment: Nutritional Treatment

  • Ryujin EndoEmail author
  • Yasuhiro Takikawa


In liver cirrhosis, the nutritional elements and the energy metabolism are disturbed, resulting in the status of protein-energy malnutrition (PEM). PEM is common in patients with liver cirrhosis and is also a significant predictor of complications and survival in these patients. On the other hand, the bleeding from esophagogastric varices is still a major and severe complication affecting the prognosis of liver cirrhosis. Although endoscopic therapy and interventional radiology therapy have been widely performed as treatments for portal hypertension, the patients often require dietary restriction after these treatments, resulting in the aggravation of PEM. It has recently become evident that late evening snack improved the status of energy malnutrition and long-term oral administration of branched-chain amino acids (BCAA) supplements decreases the progression of hepatic failure and improves the event-free survival and quality of life, as well as the serum albumin concentration, in patients with decompensated liver cirrhosis. In addition, diet with BCAA-enriched nutrient supplementation may prevent the aggravation of nutritional status in patients with liver cirrhosis during the treatment of portal hypertension.


Protein-energy malnutrition (PEM) Hepatic encephalopathy Branched-chain amino acids (BCAA) Late evening snack (LES) Liver cirrhosis 



The authors would like to thank Dr. Akinobu Kato (Department of Gastroenterology, Morioka Municipal Hospital) and Dr. Kazuyuki Suzuki (Department of Nutritional Science, Morioka University), for their assistance in creating this article.


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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Division of Medical Fundamentals for NursingIwate Medical UniversityShiwaJapan
  2. 2.Division of Hepatology, Department of Internal MedicineIwate Medical UniversityMoriokaJapan

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