During the last 20 years there has been much interest in nutritional treatment for patients with advanced
cirrhosis. Most studies have measured the potential benefit of nutritional supplements of
dietary proteins, generic
protein hydrolysates, or specific
branched-chain amino acid (BCAA)-enriched formulas in regard to nutritional parameters and
hepatic encephalopathy. The issue is not definitively settled; data are conflicting and meta-analyses have failed to produce unequivocal results. A consensus review, recently produced under the auspices of the European Society for Parenteral and
Enteral Nutrition, concluded that: (1) patients with
cirrhosis tend to be hypermetabolic, and a higher-than-normal supply of
dietary proteins is needed to achieve
nitrogen balance; (2) most patients tolerate a normal or even increased
dietary protein intake, without risk of
hepatic encephalopathy; (3) a modified eating pattern, based on several meals and a late evening snack, is useful; (4) in severely malnourished patients,
amino acid supplements may be considered to provide the necessary amount of
proteins to meet
protein requirements; (5) in a few patients intolerant to the required
protein intake, BCAA supplements may be considered to provide the necessary
nitrogen intake without detrimental effects on the mental state, perhaps even improving it. Future studies are needed to quantify the advantage of
nutritional support with
amino acids or BCAA supplements on overall well-being, complications, and ultimately survival with a long-lasting disease where self-perceived health-related quality of life is a major outcome.