Tapper Elliot B, Saleh Zachary M, Nikirk Sam, Bajaj Jasmohan, Chen Xi, Lok Anna S-F
Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
Department of Internal Medicine, Virginia Commonwealth University, Richmond VA, USA.
J Clin Exp Hepatol. 2024 Nov-Dec;14(6):101439. doi: 10.1016/j.jceh.2024.101439. Epub 2024 May 7.
Guidelines recommend that patients with hepatic encephalopathy (HE) receive a high-protein diet (roughly 1 g/kg actual body weight). Concommitant sodium restriction, low health literacy, and food insecurity limit patients' ability to meet this goal. We aimed to determine the feasibility of home-delivered high-protein medically tailored meals (MTMs) for patients with a recent episode of overt HE.
We enrolled patients with prior overt HE on active HE therapy in a 6-month trial of MTM. All received 21 home-delivered meals/week with protein snacks (mid-day and bedtime) for 12 weeks. Patients completed follow-up at week 24. The primary outcome was feasibility. Additional outcomes included change in protein and micronutrient intake (measured using 24 h dietary recalls performed by dieticians), cognitive function (Animal Naming Test [ANT]; EncephalApp Stroop), physical function (Liver Frailty Index [LFI]), and quality of life (Short Form-8 Health Survey [SF-8]). Healthcare utilization was also assessed.
Ten patients competed the study with >90% of MTM consumed. Protein intake rose from 74.6 ± 25.1 g at baseline to 93.8 ± 24.3 g on MTM ( = 0.04). Branched-chain amino acids also increased-valine 3.73 ± 1.26 g to 5.17 ± 1.28 g, isoleucine 3.32 ± 1.18 to 4.69 ± 1.55, leucine 5.83 ± 2.00 to 7.49 ± 2.07, all < 0.001. The LFI score improved from 4.42 ± 0.32 to 3.96 ± 0.82 by the end of the MTM phase ( = 0.03). SF-8 quality-of-life scores improved from 55.5 ± 15.5 at baseline to 64.7 ± 18.3 after the MTM phase, to 64.4 ± 19.1 at the end of the study ( = 0.1). EncephalApp Stroop time improved from 227 ± 94 to 194 ± 58s by the end of the MTM phase ( = 0.08). ANT scores were similarly non-significantly improved.
Home-delivered MTMs are feasible, increase protein consumption, and may improve patient wellbeing. A randomized trial is needed.
指南建议肝性脑病（HE）患者摄入高蛋白饮食（约1克/千克实际体重）。同时进行的钠限制、健康素养低和食物不安全限制了患者实现这一目标的能力。我们旨在确定为近期发生明显HE的患者提供家庭配送的高蛋白医学定制餐（MTM）的可行性。
我们招募了正在接受活动性HE治疗的既往有明显HE的患者，进行为期6个月的MTM试验。所有患者每周接受21份家庭配送餐，并在中午和睡前提供蛋白质零食，持续12周。患者在第24周完成随访。主要结局是可行性。其他结局包括蛋白质和微量营养素摄入量的变化（由营养师通过24小时饮食回顾进行测量）、认知功能（动物命名测试[ANT]；EncephalApp Stroop测试）、身体功能（肝脏衰弱指数[LFI]）和生活质量（简明健康调查简表[SF-8]）。还评估了医疗保健利用率。
10名患者完成了研究，MTM的消耗量>90%。蛋白质摄入量从基线时的74.6±25.1克增加到MTM期间的93.8±24.3克（P = 0.04）。支链氨基酸也有所增加——缬氨酸从3.73±1.26克增加到5.17±1.28克，异亮氨酸从3.32±1.18克增加到4.69±1.55克，亮氨酸从5.83±2.00克增加到7.49±2.07克，均P<0.001。到MTM阶段结束时，LFI评分从4.42±0.32改善至3.96±0.82（P = 0.03）。SF-8生活质量评分从基线时的55.5±15.5提高到MTM阶段后的64.7±18.3，在研究结束时为64.4±19.1（P = 0.1）。到MTM阶段结束时，EncephalApp Stroop测试时间从227±94秒改善至194±58秒（P = 0.08）。ANT评分同样有非显著改善。
家庭配送MTM是可行的，可增加蛋白质摄入量，并可能改善患者健康状况。需要进行一项随机试验。
