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
The implementation of nutritional strategies targeting several variables at once could benefit patients with cirrhosis. Non-alcoholic beer has different compounds that exert antioxidant, anti-inflammatory and nutritional properties.
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, patients with cirrhosis were randomized into two groups: The intervention (non-alcoholic beer + diet + exercise) and control (water + diet + exercise) group. Treatment consisted of 330 mL non-alcoholic beer/day or the same amount of water, plus an individualized dietary plan and an exercise program with a pedometer-based bracelet to reach at least 5000 steps/d and > 2500 above the baseline during 8 wk. Endothelial function (flow-mediated dilation, plethysmography), biochemical and nutritional variables and quality of life (CLDQ) were evaluated.
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 MELD score was 8 (7-10) and most patients were Child-Pugh A (88%). Adherence to the interventions was > 90% in both groups, there were no adverse events and all biochemical parameters remained stable in both groups. Endothelial function improved in both groups. All 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.
The intervention consisting of non-alcoholic beer, diet and exercise seems to be safe and well tolerated in patients with cirrhosis, and shows improvement in nutritional status, endothelial function, and quality of life. These results need to be further confirmed.
Core Tip: Malnutrition is a frequent complication in patients with cirrhosis and it is associated with adverse outcomes. Diet and physical exercise are strategies that have shown a beneficial effect on nutritional status. On the other hand, non-alcoholic beer has several nutrients including vitamin B, minerals and flavonoids that make it an attractive "functional" supplement for patients with cirrhosis. The present study evaluated the effect of a multifactorial intervention that included diet, exercise and non-alcoholic beer, showing that it is safe and well tolerated. This intervention showed improvement in endothelial function, quality of life and nutritional status including muscle mass.