Is protein restriction recommended as a strategy to reduce the risk of developing hepatic encephalopathy?

• A. Yes
• B. No
• C. Only in cirrhosis
• D. Only during acute encephalopathy

Answer: (B)

Protein restriction is not recommended as a strategy to reduce hepatic encephalopathy risk. Maintaining adequate protein intake is important in liver disease because amino acids support overall nutrition and muscle mass, and muscles help detoxify ammonia. Restricting protein can worsen malnutrition and sarcopenia, which can actually impair ammonia handling and worsen outcomes. Instead, manage encephalopathy by lowering gut ammonia production through therapies like lactulose and rifaximin, and address precipitating factors. The emphasis is on adequate protein—often with attention to protein quality (for example, plant-based or branched-chain amino acids when appropriate)—rather than restricting intake, in both cirrhosis and acute episodes.