ABSTRACT
Indication for diet therapy is given by the randomized controlled trials showing a benecial effect on clinical outcome. According to the guidelines issued by the European Society of Clinical Nutrition and Metabolism (ESPEN), there is indication for nutrition support, such as enteral feeding, when patients with cirrhosis cannot meet their nutritional requirements from normal food (Plauth et al., 2006). This is a level A recommendation based on the results of randomized trials and an earlier thorough analysis of randomized trials, which indicated that a decrease in mortality
is likely when nutrition support is given to patients with low energy and protein intake due to complications of the disease (Kondrup and Müller, 1997) (Table 22.1).
Many patients with cirrhosis have glucose intolerance or frank diabetes. A frequency of 20-30% has been reported (Gentile et al., 1993). Glucose intolerance does not seem to be related to clinical or biochemical indices of the disease nor to the etiology of the disease (Lecube et al., 2004; Müller et al., 1994b). On the other hand, glucose intolerance has been found to be related to the prognosis of patients with cirrhosis, also in a multivariate analysis (Nishida et al., 2006). Glucose intolerance seems to be due to several factors: a decrease in meal-induced insulin secretion (Marchesini et al., 1985), a higher meal-induced systemic appearance of glucose (Kruszynska et al., 1993), and a decreased peripheral glucose utilization (Proietto et al., 1980). The decreased peripheral utilization is reected in decreased glucose membrane transport and decreased nonoxidative glucose disposal, that is, glycogen synthesis (Selberg et al., 1993). Insulin-induced glucose oxidation (4-5 g/kg/day) is
