Published online Dec 27, 2020. doi: 10.4254/wjh.v12.i12.1299
Peer-review started: August 13, 2020
First decision: September 12, 2020
Revised: September 29, 2020
Accepted: October 29, 2020
Article in press: October 29, 2020
Published online: December 27, 2020
Non-alcoholic beer has been shown to positively modify gut microbiota diversity and improve endothelial function and oxidative stress, when used in different clinical settings, including breastfeeding and post-exercise rehydration. Thus, non-alcoholic beer can be regarded as a “functional” supplement. Additionally, physical exercise has proven to be a safe and effective intervention in cirrhosis, providing several benefits, for instance, improvement in nutritional status, quality of life and portal pressure.
Although nutritional therapy (diet + physical exercise) has beneficial effects in patients with cirrhosis, the availability and implementation of other nutritional strategies, such as supplements, is sometimes difficult due to different factors. Non-alcoholic beer has different compounds that exert antioxidant, anti-inflammatory and nutritional properties, and these properties are highly attractive in the treatment of patients with cirrhosis. Therefore, we hypothesize that it could be beneficial as a nutritional supplement in these patients.
The aim of the study was to evaluate the effect of diet + exercise and non-alcoholic beer on nutritional status, endothelial function, and quality of life in patients with cirrhosis.
In this randomized open-clinical trial, eligible patients were randomized into two groups: (1) Control: Diet + physical exercise and (2) Intervention: Diet + physical exercise + non-alcoholic beer who were treated for 8 wk. The evaluated outcomes were nutritional status, endothelial function, and quality of life. For the analysis, only those patients receiving at least 1 d of intervention were included (modified intention to treat). Paired data were analyzed using the Wilcoxon signed-rank test. For comparisons between groups, Mann-Whitney U or Student´s t-test was used. Areas under the curve (AUC) were constructed for repeated measurements of endothelial function.
Forty-three patients were included in the study, 21 in the control group and 22 in the intervention group. The mean age was 53.5 ± 7.8 years, 60% were women, the median model for end-stage liver disease (MELD) score was 8 (7-10) and most patients were Child-Pugh A (88%). There were no adverse effects related to the consumption of non-alcoholic beer, or to the diet and exercise. Endothelial function improved in both groups. All the measured nutritional parameters improved in the intervention group, compared to only 2 in the control group and quality of life improved in both groups; however, more domains improved in the intervention group.
A multifactorial program including the standard treatment diet and monitored exercise as well as a non-alcoholic beer is safe, well tolerated and results in improvements in endothelial function, nutritional status, and quality of life.
Non-alcoholic beer represents a new nutritional strategy that has beneficial effects in patients with cirrhosis. However, the effects shown in this study should be confirmed with a longer duration of the intervention, and possibly with a larger amount of non-alcoholic beer. Our study did not include patients with decompensated cirrhosis, which limits the extrapolation of the results.