Unlocking the Power of Late-Evening Snacks: Practical Ready-to-Prescribe Chart Menu for Patients with Cirrhosis

Laura Leoni, Filippo Valoriani, Riccardo Barbieri, Martina Pambianco, Martina Vinciguerra, Chiara Sicuro, Antonio Colecchia, Renata Menozzi, Federico Ravaioli, Laura Leoni, Filippo Valoriani, Riccardo Barbieri, Martina Pambianco, Martina Vinciguerra, Chiara Sicuro, Antonio Colecchia, Renata Menozzi, Federico Ravaioli

Abstract

The efficacy of the late-evening snack (LES) has been extensively studied due to the impact of the longest intermeal duration occurring at night in patients with cirrhosis. While actual clinical guidelines on nutrition in chronic liver disease recommend an LES, no specific nutritional compositions have been reported by the European Association for the Study of the Liver (EASL) and the European Society for Clinical Nutrition and Metabolism (ESPEN). Late-evening snacks vary greatly among studies, including natural foods and/or nutritional supplements, yet oral supplements still need to fully meet the LES's nutritional composition. In addition, many hepatologists need to gain experience in nutritional approaches and have access to registered dieticians who can help them manage patients with liver disease. Therefore, this review study aims to summarise evidence regarding using LESs and the mechanisms behind long starvation in patients with cirrhosis. It also provides a practical nutritional guide with several LES options based on common natural foods tailored to special patients' nutritional requirements and geographical backgrounds. In preventing accelerated starvation and related protein malnutrition and sarcopenia in patients with cirrhosis, the nutritional composition of LESs is essential. The proper and straightforward application of the LES's rational nutrition is an advantage to cirrhotic patients and should be carried out by healthcare professionals to enhance the overall liver function and nutritional status of patients with cirrhosis.

Keywords: ACLD; LES; advanced liver diseases; ascites; chronic liver disease; cirrhosis; fatigue; hepatic encephalopathy; muscle; nutrition; portal hypertension; sarcopenia; supplementation.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Impact of an LES on the pathophysiology of sarcopenia in cirrhosis.
Figure 2
Figure 2
Proposal for late-evening snacks. For bromatologic compositions, see Supplementary File.
Figure 3
Figure 3
Weekly meal plans for LESs based on different geographic cultures.

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