A comprehensive review evaluating the impact of protein source (vegetarian vs. meat based) in hepatic encephalopathy

Umair Iqbal, Ravirajsinh N. Jadeja, Harshit S. Khara, Sandeep Khurana

Research output: Contribution to journalArticlepeer-review

7 Scopus citations


Hepatic encephalopathy (HE) is a common neurological consequence in patients with cirrhosis and has a healthcare burden of USD 5370 to 50,120 per patient annually. HE significantly hampers the quality of life and is a major cause of morbidity and mortality. Patients with cirrhosis are at a high risk for protein-calorie malnutrition due to altered metabolism. Current evidence has changed the old belief of protein restriction in patients with cirrhosis and now 1.2 to 1.5 g/kg/day protein intake is recommended. Case series and studies with small numbers of participants showed that a vegetarian protein diet decreases the symptoms of HE when compared to a meat-based diet, but the evidence is limited and requires further larger randomized controlled trials. However, vegetable or milk-based protein diets are good substitutes for patients averse to meat intake. Branch chain amino acids (BCAA) (leucine, isoleucine and valine) have also been shown to be effective in alleviating symptoms of HE and are recommended as an alternative therapy in patients with cirrhosis for the treatment of HE. In this review, we provide an overview of current literature evaluating the role of protein intake in the management of HE in cirrhosis.

Original languageEnglish (US)
Article number370
Pages (from-to)1-15
Number of pages15
Issue number2
StatePublished - Feb 2021


  • Branch chain amino acids
  • Chronic liver disease
  • Hepatic encephalopathy
  • Meat protein
  • Vegetable protein

ASJC Scopus subject areas

  • Food Science
  • Nutrition and Dietetics


Dive into the research topics of 'A comprehensive review evaluating the impact of protein source (vegetarian vs. meat based) in hepatic encephalopathy'. Together they form a unique fingerprint.

Cite this