TREATMENT OF CIRRHOSIS OF THE LIVER BY A NUTRITIOUS DIET AND SUPPLEMENTS RICH IN VITAMIN B COMPLEX By ARTHUR J. PATEK, JR. AND JOSEPH POST (From the Research Service, First Division, Welfare Hospital, Department of Hospitals; and the Department of Medicine, College of Physicians and Surgeons, Columbia University, New York City) (Received for publication April 24, 1941) The present paper reports observations on 54 patients with cirrhosis of the liver who were treated by means of a highly nutritious diet together with vitamin B concentrates. The basis for this treatment rests on several clinical and experimental observations. It is known that the incidence of cirrhosis of the liver is high in certain countries where nutritional deficiencies are endemic (1, 2). Although malaria is blamed popularly for the high incidence of cirrhosis in these countries (3, 4), there is no direct evidence that malaria produces cirrhosis of the liver (5, 6). The association of cirrhosis and malaria suggests that the latter is a predisposing factor rather than a primary etiologic agent. The coincidence of enteric diseases with cirrhosis of the liver and with deficiency diseases may be explained similarly. In the western hemisphere cirrhosis of the liver, like beriberi and pellagra, is often associated with chronic alcoholism. Since "alcoholic" beriberi (7) and "alcoholic" pellagra (8) have been shown to be similar to the endemic beriberi and pellagra both in symptoms and response to therapy, it has been concluded that alcoholism merely predisposes to these nutritional deficiency diseases. It seemed possible that the correlation between alcoholism and cirrhosis of the liver might also be due to coexisting nutritional deficiency. Experimental evidence to support this hypothesis has accumulated in recent years. It has been known that starvation renders the liver more vulnerable to injury by hepatotoxins (9). Lack of certain food factors contained in yeast are said to cause fatty changes in the liver (10) and impaired function (11). Recent studies by Gyorgy (12) and by Rich (13) and their coworkers reveal that cirrhotic changes may possibly be produced in the rat and rabbit by feeding a diet deficient in unknown factors contained in yeast. It has also been shown that the feeding of excess fat (14) or of excess cystine (15) results in fibrotic changes in the liver. Other studies indicate a protective action against hepatotoxins by the feeding of yeast (16, 17) or of high protein diets (18, 19, 20). It is possible that a balance of food factors may be essential to the integrity of a complex organ like the liver. In a preliminary report on the treatment of 13 patients with alcoholic cirrhosis of the liver (21), it was noted that, in addition to signs of liver failure, there was evidence of specific malnutrition, notably of the vitamin B complex. These patients were fed a nutritious diet together with vitamin supplements. The improvement that followed treatment appeared to be outside chance expectations. However, since there is much variability in the degree of liver failure of different patients, and since these patients were observed for only one year, it seemed advisable to extend the program over a longer period of time. It was also important to compare their course with that of a similar group of hospitalized patients who had not received special dietary therapy.
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