Normal protein diet for episodic hepatic encephalopathy: results of a randomized study

J Hepatol. 2004 Jul;41(1):38-43. doi: 10.1016/j.jhep.2004.03.023.


Background/aims: Protein-restricted diets are usually prescribed for cirrhotic patients with hepatic encephalopathy. However, protein restriction may worsen the nutritional status without resulting in an improvement of hepatic encephalopathy. We designed a study to assess the effects of the amount of protein in the diet on the evolution of episodic hepatic encephalopathy.

Methods: Cirrhotics admitted to the hospital because of an episode of encephalopathy (n=30) were randomized to receive a low-protein diet with progressive increments or a normal protein diet for 14 days, in addition to standard measures to treat hepatic encephalopathy. Protein synthesis and breakdown were studied at day 2 and day 14 with the glycine-N(15) infusion method.

Results: The outcome of hepatic encephalopathy was not significantly different between both groups of treatment. Protein synthesis was similar for low and normal protein diet, but those of the low-protein diet group showed higher protein breakdown.

Conclusions: Diets with a normal content of protein, which are metabolically more adequate, can be administered safely to cirrhotic patients with episodic hepatic encephalopathy. Restriction of the content of protein of the diet does not appear to have any beneficial effect for cirrhotic patients during an episode of encephalopathy.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Ammonia / blood
  • Bilirubin / blood
  • Diet, Protein-Restricted*
  • Dietary Proteins / administration & dosage*
  • Dietary Proteins / pharmacokinetics
  • Female
  • Hepatic Encephalopathy / diet therapy*
  • Hepatic Encephalopathy / metabolism
  • Humans
  • Male
  • Middle Aged
  • Prothrombin / metabolism
  • Serum Albumin


  • Dietary Proteins
  • Serum Albumin
  • Ammonia
  • Prothrombin
  • Bilirubin