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• W1589001539 abstract "Weight loss and muscle wasting are commonly found in patients with end-stage liver disease. Since there is an association between malnutrition and poor clinical outcome, such patients (or those at risk of becoming malnourished) are often given parenteral nutrition, enteral nutrition, or oral nutritional supplements. These interventions have costs and adverse effects, so it is important to prove that their use results in improved morbidity or mortality, or both.To assess the beneficial and harmful effects of parenteral nutrition, enteral nutrition, and oral nutritional supplements on the mortality and morbidity of patients with underlying liver disease.The following computerised databases were searched: the Cochrane Hepato-Biliary Group Controlled Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), MEDLINE, EMBASE, and Science Citation Index Expanded (January 2012). In addition, reference lists of identified trials and review articles and Clinicaltrials.gov were searched. Trials identified in a previous systematic handsearch of Index Medicus were also considered. Handsearches of a number of medical journals, including abstracts from annual meetings, were done. Experts in the field and manufacturers of nutrient formulations were contacted for potential references.Randomised clinical trials (parallel or cross-over design) comparing groups of patients with any underlying liver disease who received, or did not receive, enteral or parenteral nutrition or oral nutritional supplements were identified without restriction on date, language, or publication status. Six categories of trials were separately considered: medical or surgical patients receiving parenteral nutrition, enteral nutrition, or supplements.The following data were sought in each report: date of publication; geographical location; inclusion and exclusion criteria; the type of nutritional support and constitution of the nutrient formulation; duration of treatment; any nutrition provided to the controls; other interventions provided to the patients; number, sex, age of the study participants; hospital or outpatient status; underlying liver disease; risks of bias (sequence generation, allocation concealment, blinding, incomplete outcome reporting, intention-to-treat analysis, selective outcome reporting, others (vested interests, baseline imbalance, early stopping)); mortality; hepatic morbidity (development or resolution of ascites or hepatic encephalopathy, occurrence of gastrointestinal bleeding); quality of life scores; adverse events; infections; lengths of stay in the hospital or intensive care unit; costs; serum bilirubin; postoperative complications (surgical trials only); and nutritional outcomes (nitrogen balance, anthropometric measurements, body weight). The primary outcomes of this review were mortality, hepatic morbidity, quality of life, and adverse events. Data were extracted in duplicate; differences were resolved by consensus.Data for each outcome were combined in a meta-analysis (RevMan 5.1). Estimates were reported using risk ratios or mean differences, along with the 95% confidence intervals (CI). Both fixed-effect and random-effects models were employed; fixed-effect models were reported unless one model, but not the other, found a significant difference (in which case both were reported). Heterogeneity was assessed by the Chi(2) test and I(2) statistic. Subgroup analyses were planned to assess specific liver diseases (alcoholic hepatitis, cirrhosis, hepatocellular carcinoma), acute or chronic liver diseases, and trials employing standard or branched-chain amino acid formulations (for the hepatic encephalopathy outcomes). Sensitivity analyses were planned to compare trials at low and high risk of bias and trials reported as full papers. The following exploratory analyses were undertaken: 1) medical and surgical trials were combined for each nutritional intervention; 2) intention-to-treat analyses in which missing dichotomous data were imputed as best- and worst-case scenarios; 3) all trials were combined to assess mortality; 4) effects were estimated by absolute risk reductions.Thirty-seven trials were identified; only one was at low risk of bias. Most of the analyses failed to find any significant differences. The significant findings that were found were the following: 1) icteric medical patients receiving parenteral nutrition had a reduced serum bilirubin (mean difference (MD) -2.86 mg%, 95% CI -3.82 mg% to -1.89 mg%, 3 trials) and better nitrogen balance (MD 3.60 g/day, 95% CI 0.86 g/day to 6.34 g/day, 1 trial); 2) surgical patients receiving parenteral nutrition had a reduced incidence of postoperative ascites only in the fixed-effect model (RR 0.65, 95% CI 0.48 to 0.87, 2 trials, I(2) = 70%) and one trial demonstrated a reduction in postoperative complications, especially infections (pneumonia in particular); 3) enteral nutrition may have improved nitrogen balance in medical patients (although a combination of the three trials was not possible); 4) one surgical trial of enteral nutrition found a reduction in postoperative complications; and 5) oral nutritional supplements had several effects in medical patients (reduced occurrence of ascites (RR 0.57, 95% CI 0.37 to 0.88, 3 trials), possibly (significant differences only seen in the fixed-effect model) reduced rates of infection (RR 0.49, 95% CI 0.24 to 0.99, 3 trials, I(2) = 14%), and improved resolution of hepatic encephalopathy (RR 3.75, 95% CI 1.15 to 12.18, 2 trials, I(2) = 79%). While there was no overall effect of the supplements on mortality in medical patients, the one low risk of bias trial found an increased risk of death in the recipients of the supplements. Three trials of supplements in surgical patients failed to show any significant differences. No new information was derived from the various subgroup or sensitivity analyses. The exploratory analyses were also unrevealing except for a logical conundrum. There was no difference in mortality when all of the trials were combined, but the trials of parenteral nutrition found that those recipients had better survival (RR 0.53, 95% CI 0.29 to 0.98, 10 trials). Either the former observation represents a type II error or the latter one a type I error.The data do not compellingly justify the routine use of parenteral nutrition, enteral nutrition, or oral nutritional supplements in patients with liver disease. The fact that all but one of these trials were at high risks of bias even casts doubt on the few benefits that were demonstrated. Data from well-designed and executed randomised trials that include an untreated control group are needed before any such recommendation can be made. Future trials have to be powered adequately to see small, but clinically important, differences." @default.
• W1589001539 created "2016-06-24" @default.
• W1589001539 creator A5015146035 @default.
• W1589001539 creator A5031065906 @default.
• W1589001539 creator A5050799721 @default.
• W1589001539 date "2012-05-16" @default.
• W1589001539 modified "2023-10-15" @default.
• W1589001539 title "Nutritional support for liver disease" @default.
• W1589001539 cites W104417043 @default.
• W1589001539 cites W113301578 @default.
• W1589001539 cites W122142001 @default.
• W1589001539 cites W130177495 @default.
• W1589001539 cites W145758881 @default.
• W1589001539 cites W1541612358 @default.
• W1589001539 cites W1552997320 @default.
• W1589001539 cites W1567638684 @default.
• W1589001539 cites W1587578293 @default.
• W1589001539 cites W179109325 @default.
• W1589001539 cites W181452036 @default.
• W1589001539 cites W1823364643 @default.
• W1589001539 cites W1827139810 @default.
• W1589001539 cites W185955167 @default.
• W1589001539 cites W1882439120 @default.
• W1589001539 cites W1904602987 @default.
• W1589001539 cites W1906121997 @default.
• W1589001539 cites W1927763767 @default.
• W1589001539 cites W1934371391 @default.
• W1589001539 cites W1964489041 @default.
• W1589001539 cites W1967888625 @default.
• W1589001539 cites W1969452713 @default.
• W1589001539 cites W1970293894 @default.
• W1589001539 cites W1971441597 @default.
• W1589001539 cites W1974757001 @default.
• W1589001539 cites W1975126412 @default.
• W1589001539 cites W1978707412 @default.
• W1589001539 cites W1979283490 @default.
• W1589001539 cites W1980167728 @default.
• W1589001539 cites W1981085899 @default.
• W1589001539 cites W1982399053 @default.
• W1589001539 cites W1983479474 @default.
• W1589001539 cites W1984570356 @default.
• W1589001539 cites W1984945109 @default.
• W1589001539 cites W1985535763 @default.
• W1589001539 cites W1987621564 @default.
• W1589001539 cites W1987640331 @default.
• W1589001539 cites W1988387725 @default.
• W1589001539 cites W1989945073 @default.
• W1589001539 cites W1990635397 @default.
• W1589001539 cites W1990773808 @default.
• W1589001539 cites W1991312820 @default.
• W1589001539 cites W1991964612 @default.
• W1589001539 cites W1992154099 @default.
• W1589001539 cites W1992321917 @default.
• W1589001539 cites W1997591925 @default.
• W1589001539 cites W1998288978 @default.
• W1589001539 cites W1999510544 @default.
• W1589001539 cites W2001276471 @default.
• W1589001539 cites W2001539686 @default.
• W1589001539 cites W2001925577 @default.
• W1589001539 cites W2002073001 @default.
• W1589001539 cites W2002158172 @default.
• W1589001539 cites W2002819317 @default.
• W1589001539 cites W200282198 @default.
• W1589001539 cites W2007425083 @default.
• W1589001539 cites W2008228713 @default.
• W1589001539 cites W2008272235 @default.
• W1589001539 cites W2008461576 @default.
• W1589001539 cites W2011202069 @default.
• W1589001539 cites W2011932878 @default.
• W1589001539 cites W2014072693 @default.
• W1589001539 cites W2014593681 @default.
• W1589001539 cites W2014707323 @default.
• W1589001539 cites W2015323967 @default.
• W1589001539 cites W2017222370 @default.
• W1589001539 cites W2017651736 @default.
• W1589001539 cites W2017821572 @default.
• W1589001539 cites W2018409103 @default.
• W1589001539 cites W2019493465 @default.
• W1589001539 cites W2021336900 @default.
• W1589001539 cites W2021636698 @default.
• W1589001539 cites W2022709298 @default.
• W1589001539 cites W2023103023 @default.
• W1589001539 cites W2025311638 @default.
• W1589001539 cites W2026698263 @default.
• W1589001539 cites W2028239595 @default.
• W1589001539 cites W2029329030 @default.
• W1589001539 cites W2029733156 @default.
• W1589001539 cites W2031436340 @default.
• W1589001539 cites W2033377518 @default.
• W1589001539 cites W2033488832 @default.
• W1589001539 cites W2035347153 @default.
• W1589001539 cites W2040263601 @default.
• W1589001539 cites W2040430837 @default.
• W1589001539 cites W2041288389 @default.
• W1589001539 cites W2043487562 @default.
• W1589001539 cites W2044989523 @default.
• W1589001539 cites W2045917145 @default.
• W1589001539 cites W2047228699 @default.
• W1589001539 cites W2048410728 @default.
• W1589001539 cites W2049852456 @default.

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