Nutritional support in liver disease - an updated systematic review.

PURPOSE OF REVIEW: The association of malnutrition and a poor prognosis does not prove that providing nutrition support improves that prognosis. The proof of such efficacy requires its demonstration in well designed and executed randomized trials. A systematic review of 40 such trials in 2014 failed to make such a finding. The purpose of this work is to update that review.

RECENT FINDINGS: A search of multiple databases identified 12 new trials (3 of enteral nutrition and 9 of nutritional supplements) comparing the nutritional intervention to standard care. Meta-analyses suggested that the provision of enteral nutrition reduced infection rates in patients undergoing liver transplantation and total complication rates after hepatic resections. Supplement usage appeared to improve mortality in patients with hepatocellular carcinoma or transplanted livers and reduce rates of ascites in patients with cirrhosis and hepatocellular carcinoma as well as improve encephalopathy resolution in those with cirrhosis. However, the risks of bias, some study designs, and the use of potentially pharmacologically active micronutrients limit the reliability of these observations.

SUMMARY: There is inadequate evidence for clinicians to be sure that nutrition support is actually of benefit to patients with liver disease.