Nutritional therapy for alcoholic hepatitis: Are we there yet?

• Published in: Hepatology (Baltimore, Md.) Md.), 1992-09, Vol.16 (3), p.845-848
• Main Authors: Morgan, Timothy R., Mendenhall, Charles L.
• Format: Article
• Language: English
• Subjects: Alcoholism and acute alcohol poisoning; Biological and medical sciences; Energy Intake; Enteral Nutrition; Hepatitis, Alcoholic - complications; Hepatitis, Alcoholic - metabolism; Hepatitis, Alcoholic - therapy; Humans; Medical sciences; Nitrogen - metabolism; Nutrition Disorders - drug therapy; Nutrition Disorders - etiology; Nutritional Status; Toxicology
• ISSN: 0270-9139; 1527-3350
• DOI: 10.1002/hep.1840160335

This prospective study compared the effects of tube‐fed nutrition with those of a regular diet in alcoholic liver disease. The high prevalence of malnutrition in patients with alcoholic liver disease requires clarification of the benefits of aggressive nutritional support. Patients were randomly assigned a regular diet without or with tube‐fed supplementation, delivering 1.5 g/kg protein and 167 kJ/kg daily. Comparisons of encephalopathy, antipyrine clearance, metabolic rate, and biochemical parameters were performed weekly for 4 weeks. Sixteen patients receiving enteral supplementation had antipyrine half‐life (50% vs. 3% reduction), serum bilirubin (25% vs. 0% reduction), and median encephalopathy scores that improved more rapidly than those of controls. Initially, 15 controls did not consume adequate calories to meet measured resting energy expenditure. Aggressive nutritional intervention accelerated improvement in alcoholic liver disease. Adverse effects did not offset the demonstrated benefits of a 2‐cal/mL, casein‐based tube‐fed supplement. These findings support the use of standard, casein‐based solutions in the treatment of alcoholic liver disease and as the control condition for future studies. The present studies were designed to provide careful measures of effects of oxandrolone, an anabolic steroid, intravenous nutritional supplementation, and the combination of these two treatments on liver functions, metabolic balances, nitrogen metabolism, and nutritional status in patients with moderate to severe alcoholic hepatitis. Of 43 patients originally recruited, 39 (19 men, 20 women) with typical clinical and laboratory features of alcoholic hepatitis (11 Child's‐Pugh class B; 28 class C) were admitted to a metabolic unit and completed a 35‐day three‐phase protocol. Phase I was a 10‐day baseline period of observation, during which routine and special quantitative tests of liver function (galactose and antipyrine metabolism), a 7‐day elemental balance study, and a 15N, 13C‐leucine metabolism study were done. Phase II was a 21‐day treatment period during which patients were randomly assigned to receive one of four regimens: 1) standard therapy, consisting of abstinence, a balanced, nutritionally adequate diet, and multivitamins; 2) oxandrolone (20 mg orally four times a day) plus standard therapy; 3) nutritional supplementation consisting of 2 L daily of 3.5% crystalline amino acids (in 6% dextrose), given by peripheral vein; or 4) a combination of ox