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We thank Dr Cardenas for his comments about our recent meta-analysis.[1, 2] We agree with his conclusions and fully support the fundamental role that nutritional assessment and nutritional supplementation play in patients with cirrhosis.

The trial by Cabre et al.[3] is an important one, and as Dr Cardenas points out, the nutritional intervention was associated with significant benefits. This trial was excluded from our meta-analysis, however, as these patients received branched chain amino acid (BCAA) supplementation. The role of BCAA-specific supplementation still requires further study. Due to the potentially unique pathophysiological properties of these agents and the fact that they are not available for routine use, we elected to exclude such BCAA trials from our review.

Acknowledgement

  1. Top of page
  2. Acknowledgement
  3. References

The authors’ declarations of personal and financial interests are unchanged from those in the original article.2

References

  1. Top of page
  2. Acknowledgement
  3. References
  • 1
    Cardenas A. Commentary: oral or enteral nutritional supplementation in cirrhosis. Aliment Pharmacol Ther 2013; 37: 10223.
  • 2
    Ney M, Vandermeer B, van Zanten SJ, Ma MM, Gramlich L, Tandon P. Meta-analysis: oral or enteral nutritional supplementation in cirrhosis. Aliment Pharmacol Ther 2013; 37: 6729.
  • 3
    Cabre E, Gonzalez-Huix F, Abad-Lacruz A, et al. Effect of total enteral nutrition on the short-term outcome of severely malnourished cirrhotics. A randomized controlled trial. Gastroenterology 1990; 98: 71520.