If a patient's nutrient intake is inadequate, he/she should be counseled to eat small, frequent meals of nutrient-dense foods. If oral intake is still inadequate, oral nutrition supplements should be considered. Several studies evaluated the effect of oral nutrition supplementation on liver disease outcomes [26-28]. Cunha et al. attempted to improve nutrition status in 29 patients with alcoholic cirrhosis .
Diet and a 500-calorie oral supplement were provided to patients; 62% of the subjects completed the 3-month trial. The intake of nonalcoholic calories increased by 48% by the end of study, and alcohol calories decreased by 77%. Subjective nutrition status improvement was associated with a concomitant improvement in the Child-Pugh score and tricep skinfold measurements. This study had promising results, but the drop-out rate was more than one-third of the population.
Positive improvements were not attributed to oral supplements in a study by Le Cornu et al. ; 42 liver transplant candidates with a midarm muscle circumference <25th percentile were given oral supplements and compared with a similar group of 43 patients who received dietary counseling, but no supplementation. Nutrient intake improved in both groups, but there was no additional benefit of oral supplementation.
In another study of patients awaiting liver transplantation , supplementation with a branched-chain supplement (n = 24) or casein-based supplement (n = 26) improved calorie and protein intake to an average of 85-90% of the goal compared with an unsupplemented control group (n = 12) who achieved only 75% of calorie and 72% of protein goals. In addition, those receiving the branched-chain amino acid supplement experienced fewer hospitalizations while awaiting transplantation than did the other groups.
A final study used an immuno-enhanced supplement (Impact, Novartis, Minneapolis, MN) for patients awaiting liver transplantation . Patients near the top of the waiting list for transplant were given 600 kcal/day of Impact. After transplantation, a combination of tube-fed and orally fed Impact was provided to the study group. The control group included 17 control patients, 11 of whom were prescribed 720 kcal/day of Ensure Plus (Ross, Columbus, OH) and 6 of whom did not received preoperative supplementation. All of the control patients received standard TF formula after transplantation. During the preoperative phase (median 55 days), body weight, body fat and total body protein increased in the study patients; body protein increased significantly more in the study vs. control group. The 1-year graft and patient survivals were 100% in both groups. This study was not a randomized trial in which the controls received matched diet and that must be taken into consideration when considering the results of this study.
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WHAT IT IS A three-phase plan that has been likened to the low-carbohydrate Atkins program because during the first two weeks, South Beach eliminates most carbs, including bread, pasta, potatoes, fruit and most dairy products. In PHASE 2, healthy carbs, including most fruits, whole grains and dairy products are gradually reintroduced, but processed carbs such as bagels, cookies, cornflakes, regular pasta and rice cakes remain on the list of foods to avoid or eat rarely.