AN EVALUATION OF DIETARY PROTEIN IN THE TREATMENT OF LIVER DISEASE
Authors: T C CHALMERS
Journal: Annals of Internal Medicine (1958)

Article1 February 1958AN EVALUATION OF DIETARY PROTEIN IN THE TREATMENT OF LIVER DISEASETHOMAS C. CHALMERS, M.D.THOMAS C. CHALMERS, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-48-2-320 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn 1937 the diet prescribed for patients with cirrhosis was kept low in protein to avoid burdening the sick liver.1Ten years later2a diet of approximately 140 gm. of protein was generally accepted, and tube feeding was prescribed for those who were comatose or otherwise could not take this amount voluntarily. After another 10 years it is stated in the most recently published textbook of medicine3that the diet "should at least be adequate in all nutrients necessary for a normal individual," and complete withdrawal of protein is advised for the patient entering into hepatic coma. Thus the pendulum...Bibliography1. Detweiler HK in Textbook of medicine, edited by Cecil, R. L., 4th Ed., 1937, W. B. Saunders Co., Philadelphia, pp. 781-804. Google Scholar2. Patek AJ in Textbook of medicine, edited by Cecil, R. L., 7th Ed., 1947, W. B. Saunders Co., Philadelphia, pp. 861-864. Google Scholar3. DavidsonMallory CSGK: Cirrhosis of the liver, in Practice of medicine, edited by Meakins, J. C., C. V. Mosby Co., St. Louis, pp. 1265-1284. Google Scholar4. Patek AJ: Treatment of alcoholic cirrhosis of the liver with high vitamin therapy, Proc. Soc. Exper. Biol. and Med. 37: 329-330, 1937. CrossrefGoogle Scholar5. GoldschmidtVarsRavdin SHMIS: The influence of the foodstuffs upon the susceptibility of the liver to injury by chloroform, and the probable mechanism of their action, J. Clin. Investigation 18: 277-289, 1939. CrossrefMedlineGoogle Scholar6. MillerWhipple LLGH: Chloroform liver injury increases as protein stores decrease, Am. J. M. Sc. 199: 204, 1940. CrossrefGoogle Scholar7. RichHamilton ARJD: Experimental production of cirrhosis of liver by means of a deficient diet, Bull. Johns Hopkins Hosp. 66: 185-198, 1940. Google Scholar8. GyorgyGoldblatt PH: Observations on conditions of dietary hepatic injury (neurosis, cirrhosis) in rats, J. Exper. Med. 75: 355-368, 1942. CrossrefMedlineGoogle Scholar9. PatekPostRatnoffMankinHillman AJJODHRW: Dietary treatment of cirrhosis of the liver, J. A. M. A. 138: 543-549, 1948. CrossrefMedlineGoogle Scholar10. RatnoffPatek ODAJ: The natural history of Laennec's cirrhosis of the liver, Medicine 21: 207-268, 1942. CrossrefGoogle Scholar11. Morrison LM: New methods of therapy in cirrhosis of the liver, J. A. M. A. 134: 673-676, 1947. CrossrefMedlineGoogle Scholar12. Kark RM: Low sodium and high protein diets in Laennec's cirrhosis, M. Clin. North America 35: 73-91, 1951. CrossrefMedlineGoogle Scholar13. CappsBarker RBMH: The management of infectious hepatitis, Ann. Int. Med. 26: 405, 1947. LinkGoogle Scholar14. Hughes JD: Treatment of infectious hepatitis by diet and rest, Bull. U. S. Army M. Dept. 4: 662, 1945. MedlineGoogle Scholar15. Hanger FM, in Textbook of medicine, edited by Cecil, R. L., 7th Ed., 1947, W. B. Saunders Co., Philadelphia, pp. 850-852. Google Scholar16. KlatskinYesner GR: Factors in the treatment of Laennec's cirrhosis. I. Clinical and histological changes observed during a control period of bed-rest, alcohol withdrawal, and a minimal basic diet, J. Clin. Investigation 28: 723-735, 1949. CrossrefGoogle Scholar17. VolwilerJonesMallory WCMTB: Criteria for the measurement of results of treatment in fatty cirrhosis, Gastroenterology 11: 164, 1948. MedlineGoogle Scholar18. EckhardtFaloonDavidson RDWWCS: Improvement of active liver cirrhosis in patients maintained with amino acids intravenously as the source of protein and lipotropic substances, J. Clin. Investigation 28: 603-614, 1949. CrossrefMedlineGoogle Scholar19. EckhardtZamcheckSidmanGabuzdaDavidson RDNRLGJCS: Effect of protein starvation and of protein feeding on the clinical course, liver function, and liver histochemistry of three patients with active fatty alcoholic cirrhosis, J. Clin. Investigation 29: 227-237, 1950. CrossrefMedlineGoogle Scholar20. PhillipsGabuzdaDavidson GBGJCS: Comparative effects of a purified and an adequate diet on the course of fatty cirrhosis in the alcoholic, J. Clin. Investigation 31: 351-356, 1952. CrossrefMedlineGoogle Scholar21. PloughForsythTeschanSborov ICBTPEVM: Studies of nitrogen balance in acute viral hepatitis, Am. J. M. Sc. 230: 182, 1955. CrossrefMedlineGoogle Scholar22. GabuzdaPhillipsDavidson GJGBCS: Reversible toxic manifestations in patients with cirrhosis of liver given cation-exchange resins, New England J. Med. 246: 124-130, 1952. CrossrefMedlineGoogle Scholar23. PhillipsSchwartzGabuzdaDavidson GBRGJCS: Syndrome of impending hepatic coma in patients with cirrhosis of liver given certain nitrogenous substances, New England J. Med. 247: 239-246, 1952. CrossrefMedlineGoogle Scholar24. SchwartzPhillipsSeegmillerGabuzdaDavidson RGBJEGJCS: Dietary protein in the genesis of hepatic coma, New England J. Med. 251: 685-689, 1954. CrossrefMedlineGoogle Scholar25. McDermottAdams WVRD: Episodic stupor associated with an Eck fistula in the human with particular reference to the metabolism of ammonia, J. Clin. Investigation 33: 1-9, 1954. CrossrefMedlineGoogle Scholar26. SherlockSummerskillWhitePhear SWHLPEA: Portal-systemic encephalopathy. Neurological complications of liver disease, Lancet 2: 453, 1954. CrossrefGoogle Scholar27. SherlockSummerskillDawson SWHAM: The treatment and prognosis of hepatic coma, Lancet 2: 689-694, 1956. CrossrefGoogle Scholar28. Davidson CS: Cirrhosis in alcoholics—protein nutrition and hepatic coma, J. A. M. A. 160: 390-391, 1956. MedlineGoogle Scholar29. HahnMassenNenckiPawlow MOMJ: Die Eck'sche Fistel zwischen der unteren Hohlvene und der Pfortader und ihre Folgen für de Organismus, Arch. f. exper. Path. u Pharmakol. 32: 161, 1893. CrossrefGoogle Scholar30. NenckiPawlowZaleski MJPJ: Ueber den Ammoniakgehalt des Blutes und der Organe die Hirnstoff Bildung bei den Saugetieren, Arch. f. exper. Path. u. Pharmakol. 37: 26, 1895. CrossrefGoogle Scholar31. PloughPatekBevans ICAJM: The relative effects of protein, choline, and methionine in the treatment of experimental dietary cirrhosis in the rat, J. Exper. Med. 96: 221-231, 1952. CrossrefMedlineGoogle Scholar32. BrandtCastlemanRuskinGreenwaldKellyJones JLLHDJJJA: The effect of oral protein and glucose feeding on splanchnic blood flow and oxygen utilization in normal and cirrhotic subjects, J. Clin. Investigation 34: 1017-1025, 1955. CrossrefMedlineGoogle Scholar33. LeoneRaterDiefenbachEadsLiebermanMurray NCFWCMGJER: Clinical evaluation of a high-protein, high-carbohydrate, restricted-fat diet in the treatment of viral hepatitis, Ann. New York Acad. Sc. 57: 948-961, 1954. CrossrefMedlineGoogle Scholar34. ChalmersEckhardtReynoldsCigarroaDeaneReifensteinSmithDavidson TCRDWEJGNRWCWCS: The treatment of acute infectious hepatitis. Controlled studies of the effects of diet, rest, and physical reconditioning on the acute course of the disease and on the incidence of relapses and residual abnormalities, J. Clin. Investigation 34: 1163-1235, 1955. CrossrefMedlineGoogle Scholar35. ForsythShipmanPlough BTMEIC: The relation of nitrogen retention to nitrogen intake in adults with post-traumatic malnutrition, J. Clin. Investigation 34: 1653, 1955. CrossrefMedlineGoogle Scholar36. GabuzdaDavidson GJCS: Protein metabolism in patients with cirrhosis of the liver, Ann. New York Acad. Sc. 57: 776-785, 1954. CrossrefMedlineGoogle Scholar37. PloughIberShipmanChalmers ICFLMETC: The effects of supplementary calories on nitrogen storage at high intakes of protein in patients with chronic liver disease, Am. J. Clin. Nutrition 4: 224-230, 1956. CrossrefMedlineGoogle Scholar38. Munro HN: Carbohydrate and fat as factors in protein utilization and metabolism, Physiol. Rev. 31: 449, 1951. CrossrefMedlineGoogle Scholar39. ReifensteinAlbrightWells ECFSL: The accumulation, interpretation, and presentation of data pertaining to metabolic balances, notably those of calcium, phosphorus, and nitrogen, J. Clin. Endocrinol. 5: 367-395, 1945. CrossrefMedlineGoogle Scholar40. KeysBrozek AJ: Body fat in adult man, Physiol. Rev. 33: 245, 1953. CrossrefMedlineGoogle Scholar41. FoleyWatsonAdams JMCWRD: Significance of the electroencephalographic changes in hepatic coma, Tr. Am. Neurol. A. 75: 161, 1950. Google Scholar42. BickfordButt RGHR: Hepatic coma: the electroencephalographic pattern, J. Clin. Investigation 34: 790-799, 1955. CrossrefMedlineGoogle Scholar43. FisherFaloon CJWW: Control of blood ammonia in cirrhosis by oral Neomycin, Clin. Res. Proc. 4: 147, 1956. Google Scholar44. McDermottWarehamRiddell WVJAG: Treatment of "hepatic coma" with 1-glutamic acid, New England J. Med. 253: 1093-1102, 1955. CrossrefMedlineGoogle Scholar45. NajarianHarper JSHA: A clinical study of the effect of arginine on blood ammonia, Am. J. Med. 21: 832-842 (Dec.) 1956. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Boston, Massachusetts*Presented at the Thirty-eighth Annual Session of The American College of Physicians, Boston, Massachusetts, April 11, 1957.From the Department of Medicine, Lemuel Shattuck Hospital, Boston, Massachusetts.Requests for reprints should be addressed to Thomas C. Chalmers, M.D., Chief of Medical Services, Lemuel Shattuck Hospital, Boston 30, Massachusetts. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byThe Management of Hepatic Coma: A Continuing ProblemPathogenesis and Treatment of Hepatic FailureThe Clinical Course of Laennec's Cirrhosis Under Modern Medical ManagementThe Management of Severe Viral HepatitisMetabolic Effects of Glutamate and Arginine Administration and Protein Restriction in Patients with Liver Disease 1 February 1958Volume 48, Issue 2Page: 320-329KeywordsCirrhosisComaDietHepatitis AHospital medicineLiver diseasesNutrientsNutritionOintmentsProteins ePublished: 1 December 2008 Issue Published: 1 February 1958 PDF downloadLoading ...