SynthesisNutrition journal2019
Zinc supplementation in patients with cirrhosis and hepatic encephalopathy: a systematic review and meta-analysis.
Synthesis in Nutrition journal, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 58 citations in OpenAlex.
- Zinc supplementation in liver cirrhosis: meta-analysis of its effect on biochemical and clinical outcomes.BMC nutrition · 2026Pooled it
- Micronutrient deficiencies in hepatic cirrhosis: Navigating challenges to assessment and implications for clinical management: A narrative review.Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition · 2026Review
- Reducing the Risk of Overt Hepatic Encephalopathy Recurrence: A Narrative Review.Journal of clinical and translational hepatology · 2026Review
- Covert hepatic encephalopathy in cirrhosis: implications for early diagnosis and appropriate management.Clinical journal of gastroenterology · 2026Review
- Metabolomics study of the effects of zinc sulfate in minimal hepatic encephalopathy.Scientific reports · 2026Article
- Review
- Risk factors, clinical outcomes, and the development of a pragmatic zinc deficiency screening tool in patients with cirrhosis: a prospective cohort study.European journal of clinical nutrition · 2026Article
- Correlation of Serum Zinc Levels with Hepatic Encephalopathy Severity in Patients with Decompensated Liver Cirrhosis: A Prospective Observational Study from Egypt.Biological trace element research · 2025Observational
- Clinical Significance of Marginal Zinc Deficiency as a Predictor of Covert Hepatic Encephalopathy in Patients with Liver Cirrhosis.International journal of molecular sciences · 2025Article
- The Effects of Adding Probiotic, Alone and in Combination With Zinc, to Routine Treatment on Recurrence of Hepatic Encephalopathy, Quality of Life, and Sleep Quality in Patients With Cirrhosis: An Open-Label Randomized Controlled Trial.Food science & nutrition · 2025Article
- Prophylaxis of hepatic encephalopathy: current and future drug targets.Hepatology international · 2024Review
- Future Therapies of Hepatic Encephalopathy.Clinics in liver disease · 2024Review
- Zinc supplementation with polaprezinc was associated with improvements in albumin, prothrombin time activity, and hemoglobin in chronic liver disease.Journal of clinical biochemistry and nutrition · 2024Article
- AASLD Practice Guidance: Palliative care and symptom-based management in decompensated cirrhosis.Hepatology (Baltimore, Md.) · 2022Article
- Evidence-based approach to management of hepatic encephalopathy in adults.World journal of hepatology · 2022Review
- Dual therapy with zinc acetate and rifaximin prevents from ethanol-induced liver fibrosis by maintaining intestinal barrier integrity.World journal of gastroenterology · 2021Article
- Moderate Alcoholic Hepatitis.Clinics in liver disease · 2021Review
- Malnutrition in Patients with Liver Cirrhosis.Nutrients · 2021Review
- Outpatient management of alcohol-related liver disease.The lancet. Gastroenterology & hepatology · 2020Review
- Recent advances in understanding and managing hepatic encephalopathy in chronic liver disease.F1000Research · 2020Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
4 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundLow serum zinc level is associated with hepatic encephalopathy (HE), but the efficacy of zinc supplementation remains uncertain. This study aimed to investigate the effects of zinc supplementation on HE treatment in patients with cirrhosis.
methodsWe searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (Cochrane CENTRAL) and Scopus from inception to December 2018; without publication date or language restrictions. Randomized controlled trials of zinc supplementation versus placebo or other treatment for the management of HE in adult patients with cirrhosis were selected. The primary outcome was the degree of HE as assessed by clinical signs or specialized psychometric tests. The secondary outcomes included serum ammonia levels, adverse events, or the length of hospital stay and costs. We carried out a meta-analysis with random effects model and summarized continuous outcomes using standardized mean differences (SMD) or mean differences (MD) with 95% confidence intervals (95% CI). The risk of bias was assessed using the Cochrane risk of bias tool, and the certainty of evidence for each outcome was evaluated with the Grading of Recommendations, Assessment, Development, and Evaluation approach.
resultsFour trials with 247 patients were included. In patients with cirrhosis who had mild HE (≤ grade II), the available evidence suggested that the combination treatment of zinc supplementation and lactulose over 3 to 6 months significantly improved performance in the number connection test (SMD: -0.97; 95% CI: - 1.75 to - 0.19; P = 0.01; moderate certainty), reported in three trials (n = 227). However, compared with lactulose therapy alone, additional zinc supplementation demonstrated no significant difference in the digit symbol test (SMD: 0.44; 95% CI: - 0.12 to 1.00; P = 0.12; very low certainty) or serum ammonia levels (MD: -10.86; 95% CI: - 25.73 to 4.01; P = 0.15; very low certainty), reported in two trials (n = 137). None of the included trials reported adverse events or effects on hospitalization.
conclusionsIn conclusion, a combination of zinc supplementation and lactulose over 3 to 6 months may improve the number connection test in cirrhotic patients with low grade HE, compared with lactulose only.
trial registrationPROSPERO: CRD42017080955 . Registered 23 November 2017.
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