Home delivery of medically tailored high-protein meals was feasible and led to increased protein intake and improvements in physical function and symptoms of hepatic encephalopathy in people with advanced liver cirrhosis, according to study results published in the Journal of Clinical and Experimental Hepatology.

Over time, chronic hepatitis B, hepatitis C, fatty liver disease, heavy alcohol use and other causes can lead to serious liver complications, including fibrosis, cirrhosis and liver cancer. People with late-stage, or decompensated, cirrhosis may develop hepatic encephalopathy, which occurs when the liver fails to filter out harmful toxins. As these toxins build up in the brain, they can affect cognitive function, leading to confusion, impaired memory, personality changes and, ultimately, coma.

Fortunately, the condition can often be managed if identified early. Historically, people with hepatic encephalopathy were advised to limit their protein intake in an effort to reduce ammonia production, but more recent evidence shows that restricting protein can be harmful. A nutritious diet is a key to good health, but many people with advanced illness experience food insecurity, or limited access to affordable healthy food, and support is growing for a “food is medicine” approach.

Elliot Tapper, MD, of the University of Michigan Health System in Ann Arbor, and colleagues studied the impact of delivering medically tailored high-protein meals to people who were receiving therapy for a recent symptomatic episode of hepatic encephalopathy (NCT04675775).

During this six-month trial, all participants received home-delivered meals for 12 weeks. The daily parcels contained three main meals as well as two high-protein snacks. The researchers assessed nutrient intake (based on dietary recalls) and conducted a variety of in-person tests to assess physical and cognitive function and quality of life.

Ten people finished the study and consumed over 90% of the tailored meals. Protein intake rose from about 75 grams per day at baseline to 94 grams at the end of the meal delivery period.

The researchers noted improvements in various indicators of physical and cognitive function. The liver frailty index, a measure of physical frailty in people with cirrhosis, improved significantly by the end of the meal delivery phase. Two measures of cognitive function, the EncephalApp Stroop and animal naming tests, showed improvement but did not reach the threshold for statistical significance. Likewise, a quality of life score (SF-8) increased by the end of the study (from 55.5 to 64.7), but this was also not a significant change.

“Home delivered medically tailored meals are feasible, increase protein consumption, and may improve patient well-being,” wrote the researchers. “A randomized trial is needed.”

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