Table 3.

A Typical Prescription to Improve Nutrition in Patients with Cirrhosis. Therapies Marked with * are not Recommended for Routine Use but may be Tried in Context of Controlled Trials.

1. Abstinence from alcohol (take psycho-social and psychiatric help if required)

2. Diet

1.2–1.5 g of protein per kg of body weight per day (a third from dairy, vegetable protein and animal protein each). Total 35–40 kcal/kg intake per day

Suggest late evening snack and early breakfast consisting of complex carbohydrates and protein

Supplement branched chain amino acids

Use tube feeding (overnight continuous drip) or parenteral nutrition in critically ill patients

Zinc, vitamin D and other micronutrient deficiency to be corrected

3. Exercise regime consisting of resistance and aerobic exercised, gently increased in a graded manner as per patient's capacity

4. Normalization of porta pressure, nonselective beta-blockers or TIPS as indicated

5. Ammonia lowering measures

Rifaxamine, laculose, aKG, BCAA

6. Hormonal therapy

Testosterone, oxandrolone, growth hormone*

7. Innovative therapies

IGF-1, myostatin inhibitors, follostatin, antioxidants, DRP1 inhibitors*

8. Liver transplantation*