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Pancreas and Hepatobiliary Tract

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Nutrition, Weight, and Digestive Health

Abstract

Malnutrition is a manifestation of both acute and chronic pancreatitis (CP) and liver disease and can play a prognostic role, while nutritional interventions can play a therapeutic role. In these conditions, malnutrition is related to disease progression (Lautz et al., Clin Investig 70(6):478–86, 1992; Arvanitakis et al., Clin Nutr 39(3):612–31, 2020). There is overlap in deficiencies seen such as fat-soluble vitamins, which may be seen in pancreatic disorders and cholestatic liver disease; however, management varies between the conditions. Nutritional interventions such as optimal protein intake in liver disease and diet strategies post-cholecystectomy are important. In this chapter, the diagnosis of acute and chronic pancreatitis will be discussed along with an overview of the management of malnutrition for these and the post-cholecystectomy situations. In the liver disease section, the role of nutrition in liver disease will be discussed followed by it the nutritional management of various manifestations of acute and chronic liver disease (Figs. 7.1 and 7.2).

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References

  1. Arvanitakis M, Ockenga J, Bezmarevic M, Gianotti L, Krznarić Ž, Lobo DN, et al. ESPEN guideline on clinical nutrition in acute and chronic pancreatitis. Clin Nutr. 2020;39(3):612–31.

    Article  PubMed  Google Scholar 

  2. Lee PJ, Papachristou GI. New insights into acute pancreatitis. Nat Rev Gastroenterol Hepatol. 2019;16(8):479–96.

    Article  CAS  PubMed  Google Scholar 

  3. StatPearls. 2020.

    Google Scholar 

  4. Swaroop VS, Chari ST, Clain JE. Severe acute pancreatitis. JAMA. 2004;291(23):2865–8.

    Article  CAS  PubMed  Google Scholar 

  5. Quinlan JD. Acute pancreatitis. Am Fam Physician. 2014;90(9):632–9.

    PubMed  Google Scholar 

  6. Browne GW, Pitchumoni CS. Pathophysiology of pulmonary complications of acute pancreatitis. World J Gastroenterol. 2006;12(44):7087–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Mookadam F, Cikes M. Images in clinical medicine. Cullen's and Turner's signs. N Engl J Med. 2005;353(13):1386.

    Article  CAS  PubMed  Google Scholar 

  8. Dickson AP, Imrie CW. The incidence and prognosis of body wall ecchymosis in acute pancreatitis. Surg Gynecol Obstet. 1984;159(4):343–7.

    CAS  PubMed  Google Scholar 

  9. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–11.

    Article  PubMed  Google Scholar 

  10. Tenner S, Baillie J, DeWitt J, Vege SS, Gastroenterology ACo. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400–15; 16.

    Article  CAS  PubMed  Google Scholar 

  11. Crockett SD, Wani S, Gardner TB, Falck-Ytter Y, Barkun AN, Committee AGAICG. American gastroenterological association institute guideline on initial management of acute pancreatitis. Gastroenterology. 2018;154(4):1096–101.

    Article  PubMed  Google Scholar 

  12. Trikudanathan G, Wolbrink DRJ, van Santvoort HC, Mallery S, Freeman M, Besselink MG. Current concepts in severe acute and necrotizing pancreatitis: an evidence-based approach. Gastroenterology. 2019;156(7):1994–2007.e3.

    Article  PubMed  Google Scholar 

  13. Al-Omran M, Albalawi ZH, Tashkandi MF, Al-Ansary LA. Enteral versus parenteral nutrition for acute pancreatitis. Cochrane Database Syst Rev. 2010;(1):CD002837.

    Google Scholar 

  14. Sobral-Oliveira MB, Faintuch J, Guarita DR, Oliveira CP, Carrilho FJ. Nutritional profile of asymptomatic alcoholic patients. Arq Gastroenterol. 2011;48(2):112–8.

    Article  PubMed  Google Scholar 

  15. Teich N, Aghdassi A, Fischer J, Walz B, Caca K, Wallochny T, et al. Optimal timing of oral refeeding in mild acute pancreatitis: results of an open randomized multicenter trial. Pancreas. 2010;39(7):1088–92.

    Article  PubMed  Google Scholar 

  16. Wu LM, Sankaran SJ, Plank LD, Windsor JA, Petrov MS. Meta-analysis of gut barrier dysfunction in patients with acute pancreatitis. Br J Surg. 2014;101(13):1644–56.

    Article  CAS  PubMed  Google Scholar 

  17. Eatock FC, Chong P, Menezes N, Murray L, McKay CJ, Carter CR, et al. A randomized study of early nasogastric versus nasojejunal feeding in severe acute pancreatitis. Am J Gastroenterol. 2005;100(2):432–9.

    Article  CAS  PubMed  Google Scholar 

  18. Kumar A, Singh N, Prakash S, Saraya A, Joshi YK. Early enteral nutrition in severe acute pancreatitis: a prospective randomized controlled trial comparing nasojejunal and nasogastric routes. J Clin Gastroenterol. 2006;40(5):431–4.

    Article  CAS  PubMed  Google Scholar 

  19. Singh N, Sharma B, Sharma M, Sachdev V, Bhardwaj P, Mani K, et al. Evaluation of early enteral feeding through nasogastric and nasojejunal tube in severe acute pancreatitis: a noninferiority randomized controlled trial. Pancreas. 2012;41(1):153–9.

    Article  PubMed  Google Scholar 

  20. Smit M, Buddingh KT, Bosma B, Nieuwenhuijs VB, Hofker HS, Zijlstra JG. Abdominal compartment syndrome and intra-abdominal ischemia in patients with severe acute pancreatitis. World J Surg. 2016;40(6):1454–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. van Brunschot S, Schut AJ, Bouwense SA, Besselink MG, Bakker OJ, van Goor H, et al. Abdominal compartment syndrome in acute pancreatitis: a systematic review. Pancreas. 2014;43(5):665–74.

    Article  PubMed  Google Scholar 

  22. Tsuei BJ, Magnuson B, Swintosky M, Flynn J, Boulanger BR, Ochoa JB, et al. Enteral nutrition in patients with an open peritoneal cavity. Nutr Clin Pract. 2003;18(3):253–8.

    Article  PubMed  Google Scholar 

  23. Burlew CC, Moore EE, Cuschieri J, Jurkovich GJ, Codner P, Nirula R, et al. Who should we feed? Western Trauma Association multi-institutional study of enteral nutrition in the open abdomen after injury. J Trauma Acute Care Surg. 2012;73(6):1380–7; discussion 7-8.

    Article  PubMed  Google Scholar 

  24. Jeurnink SM, Nijs MM, Prins HA, Greving JP, Siersema PD. Antioxidants as a treatment for acute pancreatitis: A meta-analysis. Pancreatology. 2015;15(3):203–8.

    Article  CAS  PubMed  Google Scholar 

  25. Yong L, Lu QP, Liu SH, Fan H. Efficacy of glutamine-enriched nutrition support for patients with severe acute pancreatitis: a meta-analysis. JPEN J Parenter Enteral Nutr. 2016;40(1):83–94.

    Article  CAS  PubMed  Google Scholar 

  26. Löhr JM, Dominguez-Munoz E, Rosendahl J, Besselink M, Mayerle J, Lerch MM, et al. United European Gastroenterology evidence-based guidelines for the diagnosis and therapy of chronic pancreatitis (HaPanEU). United European Gastroenterol J. 2017;5(2):153–99.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Fernandez M, Arvanitakis M, Musala C, Devière J, Van Steenbergen W, Putzeys V, et al. The Belgian national registry on chronic pancreatitis: A prospective multi-centre study covering more than 800 patients in one year. Pancreatology. 2017;17(4):572–9.

    Article  CAS  PubMed  Google Scholar 

  28. Hao L, Wang LS, Liu Y, Wang T, Guo HL, Pan J, et al. The different course of alcoholic and idiopathic chronic pancreatitis: A long-term study of 2,037 patients. PLoS One. 2018;13(6):e0198365.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Ewald N, Hardt PD. Diagnosis and treatment of diabetes mellitus in chronic pancreatitis. World J Gastroenterol. 2013;19(42):7276–81.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Gardner TB, Adler DG, Forsmark CE, Sauer BG, Taylor JR, Whitcomb DC. ACG clinical guideline: chronic pancreatitis. Am J Gastroenterol. 2020;115(3):322–39.

    Article  PubMed  Google Scholar 

  31. Machicado JD, Yadav D. Epidemiology of recurrent acute and chronic pancreatitis: similarities and differences. Dig Dis Sci. 2017;62(7):1683–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Sah RP, Pannala R, Chari ST, Sugumar A, Clain JE, Levy MJ, et al. Prevalence, diagnosis, and profile of autoimmune pancreatitis presenting with features of acute or chronic pancreatitis. Clin Gastroenterol Hepatol. 2010;8(1):91–6.

    Article  PubMed  Google Scholar 

  33. Pham A, Forsmark C. Chronic pancreatitis: review and update of etiology, risk factors, and management. F1000Res. 2018;7

    Google Scholar 

  34. Gardner TB, Levy MJ. EUS diagnosis of chronic pancreatitis. Gastrointest Endosc. 2010;71(7):1280–9.

    Article  PubMed  Google Scholar 

  35. DiMagno EP, Go VL. Exocrine pancreatic insufficiency. Current concepts of pathophysiology. Postgrad Med. 1972;52(1):135–40.

    Article  CAS  PubMed  Google Scholar 

  36. Meier R, Ockenga J, Pertkiewicz M, Pap A, Milinic N, Macfie J, et al. ESPEN guidelines on enteral nutrition: pancreas. Clin Nutr. 2006;25(2):275–84.

    Article  CAS  PubMed  Google Scholar 

  37. Schneider A, Löhr JM, Singer MV. The M-ANNHEIM classification of chronic pancreatitis: introduction of a unifying classification system based on a review of previous classifications of the disease. J Gastroenterol. 2007;42(2):101–19.

    Article  PubMed  Google Scholar 

  38. Conwell DL, Lee LS, Yadav D, Longnecker DS, Miller FH, Mortele KJ, et al. American pancreatic association practice guidelines in chronic pancreatitis: evidence-based report on diagnostic guidelines. Pancreas. 2014;43(8):1143–62.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Ramesh H. Proposal for a new grading system for chronic pancreatitis: the ABC system. J Clin Gastroenterol. 2002;35(1):67–70.

    Article  CAS  PubMed  Google Scholar 

  40. Bagul A, Siriwardena AK. Evaluation of the Manchester classification system for chronic pancreatitis. JOP. 2006;7(4):390–6.

    PubMed  Google Scholar 

  41. Rasmussen HH, Irtun O, Olesen SS, Drewes AM, Holst M. Nutrition in chronic pancreatitis. World J Gastroenterol. 2013;19(42):7267–75.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Wehler M, Nichterlein R, Fischer B, Farnbacher M, Reulbach U, Hahn EG, et al. Factors associated with health-related quality of life in chronic pancreatitis. Am J Gastroenterol. 2004;99(1):138–46.

    Article  PubMed  Google Scholar 

  43. Olesen SS, Büyükuslu A, Køhler M, Rasmussen HH, Drewes AM. Sarcopenia associates with increased hospitalization rates and reduced survival in patients with chronic pancreatitis. Pancreatology. 2019;19(2):245–51.

    Article  PubMed  Google Scholar 

  44. Hébuterne X, Hastier P, Péroux JL, Zeboudj N, Delmont JP, Rampal P. Resting energy expenditure in patients with alcoholic chronic pancreatitis. Dig Dis Sci. 1996;41(3):533–9.

    Article  PubMed  Google Scholar 

  45. Weimann A, Braga M, Harsanyi L, Laviano A, Ljungqvist O, Soeters P, et al. ESPEN guidelines on enteral nutrition: surgery including organ transplantation. Clin Nutr. 2006;25(2):224–44.

    Article  CAS  PubMed  Google Scholar 

  46. Duggan SN, Smyth ND, O'Sullivan M, Feehan S, Ridgway PF, Conlon KC. The prevalence of malnutrition and fat-soluble vitamin deficiencies in chronic pancreatitis. Nutr Clin Pract. 2014;29(3):348–54.

    Article  CAS  PubMed  Google Scholar 

  47. Sikkens EC, Cahen DL, Koch AD, Braat H, Poley JW, Kuipers EJ, et al. The prevalence of fat-soluble vitamin deficiencies and a decreased bone mass in patients with chronic pancreatitis. Pancreatology. 2013;13(3):238–42.

    Article  CAS  PubMed  Google Scholar 

  48. Caliari S, Benini L, Sembenini C, Gregori B, Carnielli V, Vantini I. Medium-chain triglyceride absorption in patients with pancreatic insufficiency. Scand J Gastroenterol. 1996;31(1):90–4.

    Article  CAS  PubMed  Google Scholar 

  49. Klapdor S, Richter E, Klapdor R. Vitamin D status and per-oral vitamin D supplementation in patients suffering from chronic pancreatitis and pancreatic cancer disease. Anticancer Res. 2012;32(5):1991–8.

    CAS  PubMed  Google Scholar 

  50. Girish BN, Rajesh G, Vaidyanathan K, Balakrishnan V. Zinc status in chronic pancreatitis and its relationship with exocrine and endocrine insufficiency. JOP. 2009;10(6):651–6.

    PubMed  Google Scholar 

  51. Lindkvist B, Domínguez-Muñoz JE, Luaces-Regueira M, Castiñeiras-Alvariño M, Nieto-Garcia L, Iglesias-Garcia J. Serum nutritional markers for prediction of pancreatic exocrine insufficiency in chronic pancreatitis. Pancreatology. 2012;12(4):305–10.

    Article  CAS  PubMed  Google Scholar 

  52. Lindkvist B, Phillips ME, Domínguez-Muñoz JE. Clinical, anthropometric and laboratory nutritional markers of pancreatic exocrine insufficiency: Prevalence and diagnostic use. Pancreatology. 2015;15(6):589–97.

    Article  CAS  PubMed  Google Scholar 

  53. Uc A, Andersen DK, Bellin MD, Bruce JI, Drewes AM, Engelhardt JF, et al. Chronic pancreatitis in the 21st century - research challenges and opportunities: summary of a national institute of diabetes and digestive and kidney diseases workshop. Pancreas. 2016;45(10):1365–75.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  54. Duggan S, O'Sullivan M, Feehan S, Ridgway P, Conlon K. Nutrition treatment of deficiency and malnutrition in chronic pancreatitis: a review. Nutr Clin Pract. 2010;25(4):362–70.

    Article  PubMed  Google Scholar 

  55. de Madaria E, Abad-González A, Aparicio JR, Aparisi L, Boadas J, Boix E, et al. The Spanish Pancreatic Club's recommendations for the diagnosis and treatment of chronic pancreatitis: part 2 (treatment). Pancreatology. 2013;13(1):18–28.

    Article  Google Scholar 

  56. Delhaye M, Van Steenbergen W, Cesmeli E, Pelckmans P, Putzeys V, Roeyen G, et al. Belgian consensus on chronic pancreatitis in adults and children: statements on diagnosis and nutritional, medical, and surgical treatment. Acta Gastroenterol Belg. 2014;77(1):47–65.

    PubMed  Google Scholar 

  57. Frulloni L, Falconi M, Gabbrielli A, Gaia E, Graziani R, Pezzilli R, et al. Italian consensus guidelines for chronic pancreatitis. Dig Liver Dis. 2010;42(Suppl 6):S381–406.

    Article  PubMed  Google Scholar 

  58. Mirtallo JM, Forbes A, McClave SA, Jensen GL, Waitzberg DL, Davies AR, et al. International consensus guidelines for nutrition therapy in pancreatitis. JPEN J Parenter Enteral Nutr. 2012;36(3):284–91.

    Article  CAS  PubMed  Google Scholar 

  59. Castiñeira-Alvariño M, Lindkvist B, Luaces-Regueira M, Iglesias-García J, Lariño-Noia J, Nieto-García L, et al. The role of high fat diet in the development of complications of chronic pancreatitis. Clin Nutr. 2013;32(5):830–6.

    Article  PubMed  CAS  Google Scholar 

  60. Caliari S, Benini L, Bonfante F, Brentegani MT, Fioretta A, Vantini I. Pancreatic extracts are necessary for the absorption of elemental and polymeric enteral diets in severe pancreatic insufficiency. Scand J Gastroenterol. 1993;28(8):749–52.

    Article  CAS  PubMed  Google Scholar 

  61. Dutta SK, Hlasko J. Dietary fiber in pancreatic disease: effect of high fiber diet on fat malabsorption in pancreatic insufficiency and in vitro study of the interaction of dietary fiber with pancreatic enzymes. Am J Clin Nutr. 1985;41(3):517–25.

    Article  CAS  PubMed  Google Scholar 

  62. Gianotti L, Meier R, Lobo DN, Bassi C, Dejong CH, Ockenga J, et al. ESPEN guidelines on parenteral nutrition: pancreas. Clin Nutr. 2009;28(4):428–35.

    Article  CAS  PubMed  Google Scholar 

  63. Silk DB. Formulation of enteral diets for use in jejunal enteral feeding. Proc Nutr Soc. 2008;67(3):270–2.

    Article  CAS  PubMed  Google Scholar 

  64. O'Brien SJ, Omer E. Chronic pancreatitis and nutrition therapy. Nutr Clin Pract. 2019;34(Suppl 1):S13–26.

    Article  PubMed  Google Scholar 

  65. Regan PT, Malagelada JR, DiMagno EP, Glanzman SL, Go VL. Comparative effects of antacids, cimetidine and enteric coating on the therapeutic response to oral enzymes in severe pancreatic insufficiency. N Engl J Med. 1977;297(16):854–8.

    Article  CAS  PubMed  Google Scholar 

  66. Layer P, von der Ohe MR, Holst JJ, Jansen JB, Grandt D, Holtmann G, et al. Altered postprandial motility in chronic pancreatitis: role of malabsorption. Gastroenterology. 1997;112(5):1624–34.

    Article  CAS  PubMed  Google Scholar 

  67. Wooldridge JL, Heubi JE, Amaro-Galvez R, Boas SR, Blake KV, Nasr SZ, et al. EUR-1008 pancreatic enzyme replacement is safe and effective in patients with cystic fibrosis and pancreatic insufficiency. J Cyst Fibros. 2009;8(6):405–17.

    Article  CAS  PubMed  Google Scholar 

  68. Shafiq N, Rana S, Bhasin D, Pandhi P, Srivastava P, Sehmby SS, et al. Pancreatic enzymes for chronic pancreatitis. Cochrane Database Syst Rev. 2009;(4):CD006302.

    Google Scholar 

  69. Domínguez-Muñoz JE, Iglesias-García J, Iglesias-Rey M, Figueiras A, Vilariño-Insua M. Effect of the administration schedule on the therapeutic efficacy of oral pancreatic enzyme supplements in patients with exocrine pancreatic insufficiency: a randomized, three-way crossover study. Aliment Pharmacol Ther. 2005;21(8):993–1000.

    Article  PubMed  CAS  Google Scholar 

  70. Greer JB, Greer P, Sandhu BS, Alkaade S, Wilcox CM, Anderson MA, et al. Nutrition and inflammatory biomarkers in chronic pancreatitis patients. Nutr Clin Pract. 2019;34(3):387–99.

    Article  CAS  PubMed  Google Scholar 

  71. Ramesh H, Reddy N, Bhatia S, Rajkumar JS, Bapaye A, Kini D, et al. A 51-week, open-label clinical trial in India to assess the efficacy and safety of pancreatin 40000 enteric-coated minimicrospheres in patients with pancreatic exocrine insufficiency due to chronic pancreatitis. Pancreatology. 2013;13(2):133–9.

    Article  CAS  PubMed  Google Scholar 

  72. Gubergrits N, Malecka-Panas E, Lehman GA, Vasileva G, Shen Y, Sander-Struckmeier S, et al. A 6-month, open-label clinical trial of pancrelipase delayed-release capsules (Creon) in patients with exocrine pancreatic insufficiency due to chronic pancreatitis or pancreatic surgery. Aliment Pharmacol Ther. 2011;33(10):1152–61.

    Article  CAS  PubMed  Google Scholar 

  73. de la Iglesia-García D, Huang W, Szatmary P, Baston-Rey I, Gonzalez-Lopez J, Prada-Ramallal G, et al. Efficacy of pancreatic enzyme replacement therapy in chronic pancreatitis: systematic review and meta-analysis. Gut. 2017;66(8):1354–5.

    PubMed  Google Scholar 

  74. FitzSimmons SC, Burkhart GA, Borowitz D, Grand RJ, Hammerstrom T, Durie PR, et al. High-dose pancreatic-enzyme supplements and fibrosing colonopathy in children with cystic fibrosis. N Engl J Med. 1997;336(18):1283–9.

    Article  CAS  PubMed  Google Scholar 

  75. Sander-Struckmeier S, Beckmann K, Janssen-van Solingen G, Pollack P. Retrospective analysis to investigate the effect of concomitant use of gastric acid-suppressing drugs on the efficacy and safety of pancrelipase/pancreatin (CREON®) in patients with pancreatic exocrine insufficiency. Pancreas. 2013;42(6):983–9.

    Article  CAS  PubMed  Google Scholar 

  76. Ní Chonchubhair HM, Bashir Y, Dobson M, Ryan BM, Duggan SN, Conlon KC. The prevalence of small intestinal bacterial overgrowth in non-surgical patients with chronic pancreatitis and pancreatic exocrine insufficiency (PEI). Pancreatology. 2018;18(4):379–85.

    Article  PubMed  Google Scholar 

  77. Ong SL, Gravante G, Pollard CA, Webb MA, Illouz S, Dennison AR. Total pancreatectomy with islet autotransplantation: an overview. HPB (Oxford). 2009;11(8):613–21.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver. 2012;6(2):172–87.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Altomare DF, Rotelli MT, Palasciano N. Diet after cholecystectomy. Curr Med Chem. 2019;26(19):3662–5.

    Article  CAS  PubMed  Google Scholar 

  80. Marcason W. What medical nutrition therapy guideline is recommended post-cholecystectomy? J Acad Nutr Diet. 2014;114(7):1136.

    Article  PubMed  Google Scholar 

  81. Shin Y, Choi D, Lee KG, Choi HS, Park Y. Association between dietary intake and postlaparoscopic cholecystectomic symptoms in patients with gallbladder disease. Korean J Intern Med. 2018;33(4):829–36.

    Article  CAS  PubMed  Google Scholar 

  82. Ge PS, Runyon BA. Treatment of patients with cirrhosis. N Engl J Med. 2016;375(21):2104–5.

    PubMed  Google Scholar 

  83. Heidelbaugh JJ, Bruderly M. Cirrhosis and chronic liver failure: part I. Diagnosis and evaluation. Am Fam Physician. 2006;74(5):756–62.

    PubMed  Google Scholar 

  84. Karlsen TH, Folseraas T, Thorburn D, Vesterhus M. Primary sclerosing cholangitis - a comprehensive review. J Hepatol. 2017;67(6):1298–323.

    Article  PubMed  Google Scholar 

  85. Hirschfield GM, Liu X, Han Y, Gorlov IP, Lu Y, Xu C, et al. Variants at IRF5-TNPO3, 17q12-21 and MMEL1 are associated with primary biliary cirrhosis. Nat Genet. 2010;42(8):655–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. Younossi ZM, Stepanova M, Younossi Y, Golabi P, Mishra A, Rafiq N, et al. Epidemiology of chronic liver diseases in the USA in the past three decades. Gut. 2020;69(3):564–8.

    Article  PubMed  Google Scholar 

  87. Collaborators GC. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020;5(3):245–66.

    Article  Google Scholar 

  88. Plauth M, Bernal W, Dasarathy S, Merli M, Plank LD, Schütz T, et al. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr. 2019;38(2):485–521.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Elwir S, Rahimi RS. Hepatic encephalopathy: an update on the pathophysiology and therapeutic options. J Clin Transl Hepatol. 2017;5(2):142–51.

    PubMed  PubMed Central  Google Scholar 

  90. Nutritional status in cirrhosis. Italian multicenter cooperative project on nutrition in liver cirrhosis. J Hepatol. 1994:317–25.

    Google Scholar 

  91. Dasarathy S. Consilience in sarcopenia of cirrhosis. J Cachexia Sarcopenia Muscle. 2012;3(4):225–37.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Merli M, Lucidi C, Giannelli V, Giusto M, Riggio O, Falcone M, et al. Cirrhotic patients are at risk for health care-associated bacterial infections. Clin Gastroenterol Hepatol. 2010;8(11):979–85.

    Article  PubMed  Google Scholar 

  93. Merli M, Giusto M, Lucidi C, Giannelli V, Pentassuglio I, Di Gregorio V, et al. Muscle depletion increases the risk of overt and minimal hepatic encephalopathy: results of a prospective study. Metab Brain Dis. 2013;28(2):281–4.

    Article  CAS  PubMed  Google Scholar 

  94. Huisman EJ, Trip EJ, Siersema PD, van Hoek B, van Erpecum KJ. Protein energy malnutrition predicts complications in liver cirrhosis. Eur J Gastroenterol Hepatol. 2011;23(11):982–9.

    Article  CAS  PubMed  Google Scholar 

  95. Borhofen SM, Gerner C, Lehmann J, Fimmers R, Görtzen J, Hey B, et al. The royal free hospital-nutritional prioritizing tool is an independent predictor of deterioration of liver function and survival in cirrhosis. Dig Dis Sci. 2016;61(6):1735–43.

    Article  CAS  PubMed  Google Scholar 

  96. Montano-Loza AJ, Angulo P, Meza-Junco J, Prado CM, Sawyer MB, Beaumont C, et al. Sarcopenic obesity and myosteatosis are associated with higher mortality in patients with cirrhosis. J Cachexia Sarcopenia Muscle. 2016;7(2):126–35.

    Article  PubMed  Google Scholar 

  97. Carias S, Castellanos AL, Vilchez V, Nair R, Dela Cruz AC, Watkins J, et al. Nonalcoholic steatohepatitis is strongly associated with sarcopenic obesity in patients with cirrhosis undergoing liver transplant evaluation. J Gastroenterol Hepatol. 2016;31(3):628–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  98. Choudhary NS, Saigal S, Saraf N, Mohanka R, Rastogi A, Goja S, et al. Sarcopenic obesity with metabolic syndrome: a newly recognized entity following living donor liver transplantation. Clin Transplant. 2015;29(3):211–5.

    Article  CAS  PubMed  Google Scholar 

  99. Dasarathy S, Merli M. Sarcopenia from mechanism to diagnosis and treatment in liver disease. J Hepatol. 2016;65(6):1232–44.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Dasarathy S. Nutrition and alcoholic liver disease: effects of alcoholism on nutrition, effects of nutrition on alcoholic liver disease, and nutritional therapies for alcoholic liver disease. Clin Liver Dis. 2016;20(3):535–50.

    Article  PubMed  PubMed Central  Google Scholar 

  101. Dasarathy S. Cause and management of muscle wasting in chronic liver disease. Curr Opin Gastroenterol. 2016;32(3):159–65.

    CAS  PubMed  PubMed Central  Google Scholar 

  102. Dasarathy J, McCullough AJ, Dasarathy S. Sarcopenia in alcoholic liver disease: clinical and molecular advances. Alcohol Clin Exp Res. 2017;41(8):1419–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  103. Rossi RE, Conte D, Massironi S. Diagnosis and treatment of nutritional deficiencies in alcoholic liver disease: Overview of available evidence and open issues. Dig Liver Dis. 2015;47(10):819–25.

    Article  PubMed  Google Scholar 

  104. Dolz C, Raurich JM, Ibáñez J, Obrador A, Marsé P, Gayá J. Ascites increases the resting energy expenditure in liver cirrhosis. Gastroenterology. 1991;100(3):738–44.

    Article  CAS  PubMed  Google Scholar 

  105. Madden AM, Morgan MY. Resting energy expenditure should be measured in patients with cirrhosis, not predicted. Hepatology. 1999;30(3):655–64.

    Article  CAS  PubMed  Google Scholar 

  106. Tajika M, Kato M, Mohri H, Miwa Y, Kato T, Ohnishi H, et al. Prognostic value of energy metabolism in patients with viral liver cirrhosis. Nutrition. 2002;18(3):229–34.

    Article  CAS  PubMed  Google Scholar 

  107. Knudsen AW, Krag A, Nordgaard-Lassen I, Frandsen E, Tofteng F, Mortensen C, et al. Effect of paracentesis on metabolic activity in patients with advanced cirrhosis and ascites. Scand J Gastroenterol. 2016;51(5):601–9.

    Article  CAS  PubMed  Google Scholar 

  108. Glass C, Hipskind P, Tsien C, Malin SK, Kasumov T, Shah SN, et al. Sarcopenia and a physiologically low respiratory quotient in patients with cirrhosis: a prospective controlled study. J Appl Physiol (1985). 2013;114(5):559–65.

    Article  CAS  Google Scholar 

  109. Glass C, Hipskind P, Cole D, Lopez R, Dasarathy S. Handheld calorimeter is a valid instrument to quantify resting energy expenditure in hospitalized cirrhotic patients: a prospective study. Nutr Clin Pract. 2012;27(5):677–88.

    Article  PubMed  PubMed Central  Google Scholar 

  110. Iwasa M, Iwata K, Hara N, Hattori A, Ishidome M, Sekoguchi-Fujikawa N, et al. Nutrition therapy using a multidisciplinary team improves survival rates in patients with liver cirrhosis. Nutrition. 2013;29(11-12):1418–21.

    Article  PubMed  Google Scholar 

  111. Plauth M, Cabré E, Riggio O, Assis-Camilo M, Pirlich M, Kondrup J, et al. ESPEN guidelines on enteral nutrition: liver disease. Clin Nutr. 2006;25(2):285–94.

    Article  CAS  PubMed  Google Scholar 

  112. Masuda K, Aoki K, Kawaguchi J, Yamakawa T, Matsuba I, Terauchi Y. Effect of caloric intake 25 or 30 kcal/kg/day on the glycemic control in obese patients with type 2 diabetes. J Clin Med Res. 2013;5(5):368–75.

    CAS  PubMed  PubMed Central  Google Scholar 

  113. Tsien CD, McCullough AJ, Dasarathy S. Late evening snack: exploiting a period of anabolic opportunity in cirrhosis. J Gastroenterol Hepatol. 2012;27(3):430–41.

    Article  CAS  PubMed  Google Scholar 

  114. Fenton JC, Knight EJ, Humpherson PL. Milk-and-cheese diet in portal-systemic encephalopathy. Lancet. 1966;1(7430):164–6.

    Article  CAS  PubMed  Google Scholar 

  115. Bianchi GP, Marchesini G, Fabbri A, Rondelli A, Bugianesi E, Zoli M, et al. Vegetable versus animal protein diet in cirrhotic patients with chronic encephalopathy. A randomized cross-over comparison. J Intern Med. 1993;233(5):385–92.

    Article  CAS  PubMed  Google Scholar 

  116. Wu G. Dietary protein intake and human health. Food Funct. 2016;7(3):1251–65.

    Article  CAS  PubMed  Google Scholar 

  117. Garrett-Laster M, Russell RM, Jacques PF. Impairment of taste and olfaction in patients with cirrhosis: the role of vitamin A. Hum Nutr Clin Nutr. 1984;38(3):203–14.

    CAS  PubMed  Google Scholar 

  118. Weismann K, Christensen E, Dreyer V. Zinc supplementation in alcoholic cirrhosis. A double-blind clinical trial. Acta Med Scand. 1979;205(5):361–6.

    CAS  PubMed  Google Scholar 

  119. Garrison RN, Cryer HM, Howard DA, Polk HC. Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis. Ann Surg. 1984;199(6):648–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  120. Merli M, Nicolini G, Angeloni S, Riggio O. Malnutrition is a risk factor in cirrhotic patients undergoing surgery. Nutrition. 2002;18(11-12):978–86.

    Article  PubMed  Google Scholar 

  121. Weimann A, Braga M, Carli F, Higashiguchi T, Hübner M, Klek S, et al. ESPEN guideline: clinical nutrition in surgery. Clin Nutr. 2017;36(3):623–50.

    Article  PubMed  Google Scholar 

  122. Coolsen MM, Wong-Lun-Hing EM, van Dam RM, van der Wilt AA, Slim K, Lassen K, et al. A systematic review of outcomes in patients undergoing liver surgery in an enhanced recovery after surgery pathways. HPB (Oxford). 2013;15(4):245–51.

    Article  PubMed  Google Scholar 

  123. Hughes MJ, McNally S, Wigmore SJ. Enhanced recovery following liver surgery: a systematic review and meta-analysis. HPB (Oxford). 2014;16(8):699–706.

    Article  PubMed  PubMed Central  Google Scholar 

  124. Sánchez CA, Papapietro VK. Perioperative nutrition in ERAS Protocols. Rev Med Chil. 2017;145(11):1447–53.

    Article  Google Scholar 

  125. Plevak DJ, DiCecco SR, Wiesner RH, Porayko MK, Wahlstrom HE, Janzow DJ, et al. Nutritional support for liver transplantation: identifying caloric and protein requirements. Mayo Clin Proc. 1994;69(3):225–30.

    Article  CAS  PubMed  Google Scholar 

  126. Reilly J, Mehta R, Teperman L, Cemaj S, Tzakis A, Yanaga K, et al. Nutritional support after liver transplantation: a randomized prospective study. JPEN J Parenter Enteral Nutr. 1990;14(4):386–91.

    Article  CAS  PubMed  Google Scholar 

  127. Hilscher MB, Kamath PS, Eaton JE. Cholestatic liver diseases: a primer for generalists and subspecialists. Mayo Clin Proc. 2020;95(10):2263–79.

    Article  PubMed  Google Scholar 

  128. Send SR. Nutritional management of cholestasis. Clin Liver Dis (Hoboken). 2020;15(1):9–12.

    Article  PubMed  PubMed Central  Google Scholar 

  129. Mccray S, Parrish C. When chyle leaks: nutrition management options. 2004:68–72.

    Google Scholar 

  130. Assis DN. Chronic complications of cholestasis: evaluation and management. Clin Liver Dis. 2018;22(3):533–44.

    Article  PubMed  Google Scholar 

  131. Bresci G, Parisi G, Banti S. Management of hepatic encephalopathy with oral zinc supplementation: a long-term treatment. Eur J Med. 1993;2(7):414–6.

    CAS  PubMed  Google Scholar 

  132. Reding P, Duchateau J, Bataille C. Oral zinc supplementation improves hepatic encephalopathy. Results of a randomised controlled trial. Lancet. 1984;2(8401):493–5.

    Article  CAS  PubMed  Google Scholar 

  133. Riggio O, Ariosto F, Merli M, Caschera M, Zullo A, Balducci G, et al. Short-term oral zinc supplementation does not improve chronic hepatic encephalopathy. Results of a double-blind crossover trial. Dig Dis Sci. 1991;36(9):1204–8.

    Article  CAS  PubMed  Google Scholar 

  134. Nardelli S, Lattanzi B, Torrisi S, Greco F, Farcomeni A, Gioia S, et al. Sarcopenia is risk factor for development of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt placement. Clin Gastroenterol Hepatol. 2017;15(6):934–6.

    Article  PubMed  Google Scholar 

  135. Olde Damink SW, Jalan R, Deutz NE, Redhead DN, Dejong CH, Hynd P, et al. The kidney plays a major role in the hyperammonemia seen after simulated or actual GI bleeding in patients with cirrhosis. Hepatology. 2003;37(6):1277–85.

    Article  PubMed  Google Scholar 

  136. Chatauret N, Desjardins P, Zwingmann C, Rose C, Rao KV, Butterworth RF. Direct molecular and spectroscopic evidence for increased ammonia removal capacity of skeletal muscle in acute liver failure. J Hepatol. 2006;44(6):1083–8.

    Article  CAS  PubMed  Google Scholar 

  137. Kearns PJ, Young H, Garcia G, Blaschke T, O'Hanlon G, Rinki M, et al. Accelerated improvement of alcoholic liver disease with enteral nutrition. Gastroenterology. 1992;102(1):200–5.

    Article  CAS  PubMed  Google Scholar 

  138. Morgan TR, Moritz TE, Mendenhall CL, Haas R. Protein consumption and hepatic encephalopathy in alcoholic hepatitis. VA Cooperative Study Group #275. J Am Coll Nutr. 1995;14(2):152–8.

    Article  CAS  PubMed  Google Scholar 

  139. Kondrup J, Nielsen K, Juul A. Effect of long-term refeeding on protein metabolism in patients with cirrhosis of the liver. Br J Nutr. 1997;77(2):197–212.

    Article  CAS  PubMed  Google Scholar 

  140. Cabre E, Gonzalez-Huix F, Abad-Lacruz A, Esteve M, Acero D, Fernandez-Bañares F, et al. Effect of total enteral nutrition on the short-term outcome of severely malnourished cirrhotics. A randomized controlled trial. Gastroenterology. 1990;98(3):715–20.

    Article  CAS  PubMed  Google Scholar 

  141. Córdoba J, López-Hellín J, Planas M, Sabín P, Sanpedro F, Castro F, et al. Normal protein diet for episodic hepatic encephalopathy: results of a randomized study. J Hepatol. 2004;41(1):38–43.

    Article  PubMed  CAS  Google Scholar 

  142. Krenitsky J. Nutrition for patients with hepatic failure. Pract Gastroenterol. 2003;6:23–42.

    Google Scholar 

  143. Kawaguchi T, Taniguchi E, Sata M. Effects of oral branched-chain amino acids on hepatic encephalopathy and outcome in patients with liver cirrhosis. Nutr Clin Pract. 2013;28(5):580–8.

    Article  PubMed  Google Scholar 

  144. Gluud LL, Dam G, Les I, Marchesini G, Borre M, Aagaard NK, et al. Branched-chain amino acids for people with hepatic encephalopathy. Cochrane Database Syst Rev. 2017;5:CD001939.

    Google Scholar 

  145. Mendenhall CL, Moritz TE, Roselle GA, Morgan TR, Nemchausky BA, Tamburro CH, et al. A study of oral nutritional support with oxandrolone in malnourished patients with alcoholic hepatitis: results of a Department of Veterans Affairs cooperative study. Hepatology. 1993;17(4):564–76.

    Article  CAS  PubMed  Google Scholar 

  146. Paternostro R, Wagner D, Reiberger T, Mandorfer M, Schwarzer R, Ferlitsch M, et al. Low 25-OH-vitamin D levels reflect hepatic dysfunction and are associated with mortality in patients with liver cirrhosis. Wien Klin Wochenschr. 2017;129(1-2):8–15.

    Article  CAS  PubMed  Google Scholar 

  147. Koretz RL, Avenell A, Lipman TO. Nutritional support for liver disease. Cochrane Database Syst Rev. 2012;(5):CD008344.

    Google Scholar 

  148. Antar R, Wong P, Ghali P. A meta-analysis of nutritional supplementation for management of hospitalized alcoholic hepatitis. Can J Gastroenterol. 2012;26(7):463–7.

    Article  PubMed  PubMed Central  Google Scholar 

  149. Fialla AD, Israelsen M, Hamberg O, Krag A, Gluud LL. Nutritional therapy in cirrhosis or alcoholic hepatitis: a systematic review and meta-analysis. Liver Int. 2015;35(9):2072–8.

    Article  PubMed  Google Scholar 

  150. Moreno C, Deltenre P, Senterre C, Louvet A, Gustot T, Bastens B, et al. Intensive enteral nutrition is ineffective for patients with severe alcoholic hepatitis treated with corticosteroids. Gastroenterology. 2016;150(4):903–10.e8.

    Article  CAS  PubMed  Google Scholar 

  151. John WJ, Phillips R, Ott L, Adams LJ, McClain CJ. Resting energy expenditure in patients with alcoholic hepatitis. JPEN J Parenter Enteral Nutr. 1989;13(2):124–7.

    Article  CAS  PubMed  Google Scholar 

  152. Verboeket-van de Venne WP, Westerterp KR, van Hoek B, Swart GR. Energy expenditure and substrate metabolism in patients with cirrhosis of the liver: effects of the pattern of food intake. Gut. 1995;36(1):110–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  153. Zillikens MC, van den Berg JW, Wattimena JL, Rietveld T, Swart GR. Nocturnal oral glucose supplementation. The effects on protein metabolism in cirrhotic patients and in healthy controls. J Hepatol. 1993;17(3):377–83.

    Article  CAS  PubMed  Google Scholar 

  154. Swart GR, Zillikens MC, van Vuure JK, van den Berg JW. Effect of a late evening meal on nitrogen balance in patients with cirrhosis of the liver. BMJ. 1989;299(6709):1202–3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  155. Plank LD, Gane EJ, Peng S, Muthu C, Mathur S, Gillanders L, et al. Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: a randomized 12-month trial. Hepatology. 2008;48(2):557–66.

    Article  PubMed  Google Scholar 

  156. Plauth M, Cabré E, Campillo B, Kondrup J, Marchesini G, Schütz T, et al. ESPEN guidelines on parenteral nutrition: hepatology. Clin Nutr. 2009;28(4):436–44.

    Article  PubMed  Google Scholar 

  157. Hu J, Juan W, Sahyoun NR. Intake and biomarkers of folate and risk of cancer morbidity in older adults, NHANES 1999-2002 with Medicare Linkage. PLoS One. 2016;11(2):e0148697.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  158. Demir R, Acar G, Tanriover G, Seval Y, Kayisli UA, Agar A. Effects of excess vitamin B6 intake on cerebral cortex neurons in rat: an ultrastructural study. Folia Histochem Cytobiol. 2005;43(3):143–50.

    CAS  PubMed  Google Scholar 

  159. Kaur P, Mishra SK, Mithal A. Vitamin D toxicity resulting from overzealous correction of vitamin D deficiency. Clin Endocrinol (Oxf). 2015;83(3):327–31.

    Article  CAS  PubMed  Google Scholar 

  160. Kappus MR. Acute hepatic failure and nutrition. Nutr Clin Pract. 2020;35(1):30–5.

    Article  PubMed  Google Scholar 

  161. Clemmesen JO, Kondrup J, Ott P. Splanchnic and leg exchange of amino acids and ammonia in acute liver failure. Gastroenterology. 2000;118(6):1131–9.

    Article  CAS  PubMed  Google Scholar 

  162. Record CO, Buxton B, Chase RA, Curzon G, Murray-Lyon IM, Williams R. Plasma and brain amino acids in fulminant hepatic failure and their relationship to hepatic encephalopathy. Eur J Clin Invest. 1976;6(5):387–94.

    Article  CAS  PubMed  Google Scholar 

  163. Rosen HM, Yoshimura N, Hodgman JM, Fischer JE. Plasma amino acid patterns in hepatic encephalopathy of differing etiology. Gastroenterology. 1977;72(3):483–7.

    Article  CAS  PubMed  Google Scholar 

  164. Bernuau J, Rueff B, Benhamou JP. Fulminant and subfulminant liver failure: definitions and causes. Semin Liver Dis. 1986;6(2):97–106.

    Article  CAS  PubMed  Google Scholar 

  165. R S, C T, A T, S S. Fulminating hepatitis with recurrent hypoglycemia and hemorrhage. Gastroenterology. 1967:291–300.

    Google Scholar 

  166. Vilstrup H, Iversen J, Tygstrup N. Glucoregulation in acute liver failure. Eur J Clin Invest. 1986;16(3):193–7.

    Article  CAS  PubMed  Google Scholar 

  167. Rutherford A, Davern T, Hay JE, Murray NG, Hassanein T, Lee WM, et al. Influence of high body mass index on outcome in acute liver failure. Clin Gastroenterol Hepatol. 2006;4(12):1544–9.

    Article  PubMed  Google Scholar 

  168. Wendon J, Cordoba J, Dhawan A, Larsen FS, Manns M, Samuel D, et al. EASL clinical practical guidelines on the management of acute (fulminant) liver failure. J Hepatol. 2017;66(5):1047–81.

    Article  PubMed  Google Scholar 

  169. Harvey SE, Parrott F, Harrison DA, Bear DE, Segaran E, Beale R, et al. Trial of the route of early nutritional support in critically ill adults. N Engl J Med. 2014;371(18):1673–84.

    Article  PubMed  CAS  Google Scholar 

  170. Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365(6):506–17.

    Article  CAS  PubMed  Google Scholar 

  171. Perumpail BJ, Khan MA, Yoo ER, Cholankeril G, Kim D, Ahmed A. Clinical epidemiology and disease burden of nonalcoholic fatty liver disease. World J Gastroenterol. 2017;23(47):8263–76.

    Article  PubMed  PubMed Central  Google Scholar 

  172. Angulo P, Kleiner DE, Dam-Larsen S, Adams LA, Bjornsson ES, Charatcharoenwitthaya P, et al. Liver fibrosis, but no other histologic features, is associated with long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology. 2015;149(2):389–97.e10.

    Article  PubMed  Google Scholar 

  173. Caldwell S, Argo C. The natural history of non-alcoholic fatty liver disease. Dig Dis. 2010;28(1):162–8.

    Article  PubMed  CAS  Google Scholar 

  174. Musso G, Gambino R, Cassader M, Pagano G. Meta-analysis: natural history of non-alcoholic fatty liver disease (NAFLD) and diagnostic accuracy of non-invasive tests for liver disease severity. Ann Med. 2011;43(8):617–49.

    Article  PubMed  Google Scholar 

  175. Targher G, Day CP. Liver enzymes, nonalcoholic fatty liver disease, and incident cardiovascular disease. Hepatology. 2011;53(1):375.

    Article  PubMed  Google Scholar 

  176. Armstrong MJ, Adams LA, Canbay A, Syn WK. Extrahepatic complications of nonalcoholic fatty liver disease. Hepatology. 2014;59(3):1174–97.

    Article  CAS  PubMed  Google Scholar 

  177. Pierantonelli I, Svegliati-Baroni G. Nonalcoholic fatty liver disease: basic pathogenetic mechanisms in the progression from NAFLD to NASH. Transplantation. 2019;103(1):e1–e13.

    Article  CAS  PubMed  Google Scholar 

  178. Barker KB, Palekar NA, Bowers SP, Goldberg JE, Pulcini JP, Harrison SA. Non-alcoholic steatohepatitis: effect of Roux-en-Y gastric bypass surgery. Am J Gastroenterol. 2006;101(2):368–73.

    Article  PubMed  Google Scholar 

  179. Caiazzo R, Lassailly G, Leteurtre E, Baud G, Verkindt H, Raverdy V, et al. Roux-en-Y gastric bypass versus adjustable gastric banding to reduce nonalcoholic fatty liver disease: a 5-year controlled longitudinal study. Ann Surg. 2014;260(5):893–8; discussion 8-9.

    Article  PubMed  Google Scholar 

  180. Dixon JB, Bhathal PS, O'Brien PE. Weight loss and non-alcoholic fatty liver disease: falls in gamma-glutamyl transferase concentrations are associated with histologic improvement. Obes Surg. 2006;16(10):1278–86.

    Article  PubMed  Google Scholar 

  181. Harrison SA, Fecht W, Brunt EM, Neuschwander-Tetri BA. Orlistat for overweight subjects with nonalcoholic steatohepatitis: A randomized, prospective trial. Hepatology. 2009;49(1):80–6.

    Article  CAS  PubMed  Google Scholar 

  182. Harrison SA, Fincke C, Helinski D, Torgerson S, Hayashi P. A pilot study of orlistat treatment in obese, non-alcoholic steatohepatitis patients. Aliment Pharmacol Ther. 2004;20(6):623–8.

    Article  CAS  PubMed  Google Scholar 

  183. Lassailly G, Caiazzo R, Buob D, Pigeyre M, Verkindt H, Labreuche J, et al. Bariatric surgery reduces features of nonalcoholic steatohepatitis in morbidly obese patients. Gastroenterology. 2015;149(2):379–88; quiz e15-6.

    Google Scholar 

  184. Stratopoulos C, Papakonstantinou A, Terzis I, Spiliadi C, Dimitriades G, Komesidou V, et al. Changes in liver histology accompanying massive weight loss after gastroplasty for morbid obesity. Obes Surg. 2005;15(8):1154–60.

    Article  PubMed  Google Scholar 

  185. Tendler D, Lin S, Yancy WS, Mavropoulos J, Sylvestre P, Rockey DC, et al. The effect of a low-carbohydrate, ketogenic diet on nonalcoholic fatty liver disease: a pilot study. Dig Dis Sci. 2007;52(2):589–93.

    Article  CAS  PubMed  Google Scholar 

  186. Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, Torres-Gonzalez A, Gra-Oramas B, Gonzalez-Fabian L, et al. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology. 2015;149(2):367–78.e5; quiz e14-5.

    Google Scholar 

  187. Miller EF. Nutrition management strategies for nonalcoholic fatty liver disease: treatment and prevention. Clin Liver Dis (Hoboken). 2020;15(4):144–8.

    Article  PubMed  PubMed Central  Google Scholar 

  188. Haufe S, Engeli S, Kast P, Böhnke J, Utz W, Haas V, et al. Randomized comparison of reduced fat and reduced carbohydrate hypocaloric diets on intrahepatic fat in overweight and obese human subjects. Hepatology. 2011;53(5):1504–14.

    Article  CAS  PubMed  Google Scholar 

  189. Huang MA, Greenson JK, Chao C, Anderson L, Peterman D, Jacobson J, et al. One-year intense nutritional counseling results in histological improvement in patients with non-alcoholic steatohepatitis: a pilot study. Am J Gastroenterol. 2005;100(5):1072–81.

    Article  PubMed  Google Scholar 

  190. Promrat K, Kleiner DE, Niemeier HM, Jackvony E, Kearns M, Wands JR, et al. Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. Hepatology. 2010;51(1):121–9.

    Article  CAS  PubMed  Google Scholar 

  191. Zelber-Sagi S, Kessler A, Brazowsky E, Webb M, Lurie Y, Santo M, et al. A double-blind randomized placebo-controlled trial of orlistat for the treatment of nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol. 2006;4(5):639–44.

    Article  CAS  PubMed  Google Scholar 

  192. Hickman IJ, Jonsson JR, Prins JB, Ash S, Purdie DM, Clouston AD, et al. Modest weight loss and physical activity in overweight patients with chronic liver disease results in sustained improvements in alanine aminotransferase, fasting insulin, and quality of life. Gut. 2004;53(3):413–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  193. Nobili V, Manco M, Devito R, Di Ciommo V, Comparcola D, Sartorelli MR, et al. Lifestyle intervention and antioxidant therapy in children with nonalcoholic fatty liver disease: a randomized, controlled trial. Hepatology. 2008;48(1):119–28.

    Article  CAS  PubMed  Google Scholar 

  194. Lim JS, Mietus-Snyder M, Valente A, Schwarz JM, Lustig RH. The role of fructose in the pathogenesis of NAFLD and the metabolic syndrome. Nat Rev Gastroenterol Hepatol. 2010;7(5):251–64.

    Article  CAS  PubMed  Google Scholar 

  195. Houghton D, Thoma C, Hallsworth K, Cassidy S, Hardy T, Burt AD, et al. Exercise reduces liver lipids and visceral adiposity in patients with nonalcoholic steatohepatitis in a randomized controlled trial. Clin Gastroenterol Hepatol. 2017;15(1):96–102.e3.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  196. Johnson NA, Sachinwalla T, Walton DW, Smith K, Armstrong A, Thompson MW, et al. Aerobic exercise training reduces hepatic and visceral lipids in obese individuals without weight loss. Hepatology. 2009;50(4):1105–12.

    Article  CAS  PubMed  Google Scholar 

  197. Sullivan S, Kirk EP, Mittendorfer B, Patterson BW, Klein S. Randomized trial of exercise effect on intrahepatic triglyceride content and lipid kinetics in nonalcoholic fatty liver disease. Hepatology. 2012;55(6):1738–45.

    Article  CAS  PubMed  Google Scholar 

  198. Thomas EL, Brynes AE, Hamilton G, Patel N, Spong A, Goldin RD, et al. Effect of nutritional counselling on hepatic, muscle and adipose tissue fat content and distribution in non-alcoholic fatty liver disease. World J Gastroenterol. 2006;12(36):5813–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  199. Markova M, Pivovarova O, Hornemann S, Sucher S, Frahnow T, Wegner K, et al. Isocaloric diets high in animal or plant protein reduce liver fat and inflammation in individuals with type 2 diabetes. Gastroenterology. 2017;152(3):571–85.e8.

    Article  CAS  PubMed  Google Scholar 

  200. Gelli C, Tarocchi M, Abenavoli L, Di Renzo L, Galli A, De Lorenzo A. Effect of a counseling-supported treatment with the Mediterranean diet and physical activity on the severity of the non-alcoholic fatty liver disease. World J Gastroenterol. 2017;23(17):3150–62.

    Article  PubMed  PubMed Central  Google Scholar 

  201. Katsagoni CN, Georgoulis M, Papatheodoridis GV, Fragopoulou E, Ioannidou P, Papageorgiou M, et al. Associations between lifestyle characteristics and the presence of nonalcoholic fatty liver disease: a case-control study. Metab Syndr Relat Disord. 2017;15(2):72–9.

    Article  CAS  PubMed  Google Scholar 

  202. Misciagna G, Del Pilar DM, Caramia DV, Bonfiglio C, Franco I, Noviello MR, et al. Effect of a low glycemic index mediterranean diet on non-alcoholic fatty liver disease. a randomized controlled clinici trial. J Nutr Health Aging. 2017;21(4):404–12.

    Article  CAS  PubMed  Google Scholar 

  203. Pérez-Guisado J, Muñoz-Serrano A. The effect of the Spanish Ketogenic Mediterranean Diet on nonalcoholic fatty liver disease: a pilot study. J Med Food. 2011;14(7-8):677–80.

    Article  PubMed  Google Scholar 

  204. Ryan MC, Itsiopoulos C, Thodis T, Ward G, Trost N, Hofferberth S, et al. The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. J Hepatol. 2013;59(1):138–43.

    Article  CAS  PubMed  Google Scholar 

  205. Shai I, Schwarzfuchs D, Henkin Y, Shahar DR, Witkow S, Greenberg I, et al. Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet. N Engl J Med. 2008;359(3):229–41.

    Article  CAS  PubMed  Google Scholar 

  206. Trovato GM, Catalano D, Martines GF, Pace P, Trovato FM. Mediterranean diet: Relationship with anxiety and depression. Ann Neurol. 2014;75(4):613.

    Article  PubMed  Google Scholar 

  207. Aller R, Izaola O, de la Fuente B, De Luis Román DA. Mediterranean diet is associated with liver histology in patients with non alcoholic fatty liver disease. Nutr Hosp. 2015;32(6):2518–24.

    CAS  PubMed  Google Scholar 

  208. Della Corte C, Mosca A, Vania A, Alterio A, Iasevoli S, Nobili V. Good adherence to the Mediterranean diet reduces the risk for NASH and diabetes in pediatric patients with obesity: the results of an Italian Study. Nutrition. 2017;39-40:8–14.

    Article  PubMed  Google Scholar 

  209. Kontogianni MD, Tileli N, Margariti A, Georgoulis M, Deutsch M, Tiniakos D, et al. Adherence to the Mediterranean diet is associated with the severity of non-alcoholic fatty liver disease. Clin Nutr. 2014;33(4):678–83.

    Article  CAS  PubMed  Google Scholar 

  210. Trovato FM, Martines GF, Brischetto D, Trovato G, Catalano D. Neglected features of lifestyle: Their relevance in non-alcoholic fatty liver disease. World J Hepatol. 2016;8(33):1459–65.

    Article  PubMed  PubMed Central  Google Scholar 

  211. Tzima N, Pitsavos C, Panagiotakos DB, Chrysohoou C, Polychronopoulos E, Skoumas J, et al. Adherence to the Mediterranean diet moderates the association of aminotransferases with the prevalence of the metabolic syndrome; the ATTICA study. Nutr Metab (Lond). 2009;6:30.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  212. Plaz Torres MC, Aghemo A, Lleo A, Bodini G, Furnari M, Marabotto E, et al. Mediterranean diet and NAFLD: what we know and questions that still need to be answered. Nutrients. 2019;11(12)

    Google Scholar 

  213. EASL) EAftSotL, (EASD) EAftSoD, (EASO) EAftSoO. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388–402.

    Article  Google Scholar 

  214. Sanyal AJ, Mofrad PS, Contos MJ, Sargeant C, Luketic VA, Sterling RK, et al. A pilot study of vitamin E versus vitamin E and pioglitazone for the treatment of nonalcoholic steatohepatitis. Clin Gastroenterol Hepatol. 2004;2(12):1107–15.

    Article  CAS  PubMed  Google Scholar 

  215. Singh S, Khera R, Allen AM, Murad MH, Loomba R. Comparative effectiveness of pharmacological interventions for nonalcoholic steatohepatitis: a systematic review and network meta-analysis. Hepatology. 2015;62(5):1417–32.

    Article  CAS  PubMed  Google Scholar 

  216. Miller ER, Pastor-Barriuso R, Dalal D, Riemersma RA, Appel LJ, Guallar E. Meta-analysis: high-dosage vitamin E supplementation may increase all-cause mortality. Ann Intern Med. 2005;142(1):37–46.

    Article  CAS  PubMed  Google Scholar 

  217. Chachay VS, Kirkpatrick CM, Hickman IJ, Ferguson M, Prins JB, Martin JH. Resveratrol--pills to replace a healthy diet? Br J Clin Pharmacol. 2011;72(1):27–38.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  218. Guo H, Zhong R, Liu Y, Jiang X, Tang X, Li Z, et al. Effects of bayberry juice on inflammatory and apoptotic markers in young adults with features of non-alcoholic fatty liver disease. Nutrition. 2014;30(2):198–203.

    Article  CAS  PubMed  Google Scholar 

  219. Ipsen DH, Tveden-Nyborg P, Lykkesfeldt J. Does vitamin C deficiency promote fatty liver disease development? Nutrients. 2014;6(12):5473–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  220. Musa-Veloso K, Venditti C, Lee HY, Darch M, Floyd S, West S, et al. Systematic review and meta-analysis of controlled intervention studies on the effectiveness of long-chain omega-3 fatty acids in patients with nonalcoholic fatty liver disease. Nutr Rev. 2018;76(8):581–602.

    Article  PubMed  PubMed Central  Google Scholar 

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Shah, R., Satyavada, S., Davitkov, P. (2022). Pancreas and Hepatobiliary Tract. In: Newberry, C., Laster, J., Pickett-Blakely, O. (eds) Nutrition, Weight, and Digestive Health. Springer, Cham. https://doi.org/10.1007/978-3-030-94953-2_7

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