Avaliação nutricional no paciente cirrótico: uma abordagem objetiva, subjetiva ou multicompartimental?

Ritter, Luciana Gregory; Gazzola, Jussara

doi:10.1590/s0004-28032006000100016

Cited by 22 publications

(14 citation statements)

References 19 publications

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“…However, it is noteworthy that 12 (48%) patients had an intake below the recommended and 36% above, this because it occurred wide variations in caloric intake, meaning that some patients had very high caloric intake and others, very low (2012±720 kcal/day). This fact characterizes what the literature have show, that chronic liver disease patients have a decreased food intake due to the disease's symptoms and dietary restrictions, which are often imposed therapeutically (8,23,31,33) . Low dietary intake has been considered as one of the major factors causing malnutrition (19) .…”

Section: Discussionmentioning

confidence: 63%

Food Consumption of Cirrhotic Patients, Comparison With the Nutritional Status and Disease Staging

Nunes

Bassani

Fernandes

et al. 2016

Arq. Gastroenterol.

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-Background -Patients with liver disease often present protein-energy malnutrition. The assessment of food intake is very important in the investigation regarding the "health-disease" process. Objective -To assess dietary intake of cirrhotic patients through food record during 3 days, correlating it with the nutritional status of the patient and the stage of the disease. Methods -Cirrhotic outpatients from the Santa Casa de Misericórdia Hospital, RS, Brazil, were assessed. Nutritional assessment was performed by anthropometry; non-dominating handgrip strength; adductor pollicis muscle thickness; phase angle by bioelectrical impedance analysis; and Subjective Global Assessment. For analysis of food consumption we used the food records of 3 days using scales for weighing of all foods. Results -We evaluated 25 (68%) patients, in which there was a prevalence of cirrhosis by hepatitis C virus. The upper arm circumference, handgrip strength and phase angle by bioelectrical impedance analysis diagnosed 56% of malnourished. Phase angle by bioelectrical impedance analysis and upper arm circumference were associated with Child-Pugh score (P<0.05). The average consumption of calories, carbohydrates, proteins and lipids were within the recommended. However, sodium was above the recommendations, 106±57.2 mEq, and was inversely associated with Child-Pugh score (rs=-0.410; P=0.042). Conclusion -Food intake did not have a significant difference between the Child-Pugh scores and nutritional status. In addition, food intake did not vary neither according to the stage of the disease, nor to the nutritional assessment, by the phase angle by bioelectrical impedance analysis.

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Section: Discussionmentioning

confidence: 63%

Food Consumption of Cirrhotic Patients, Comparison With the Nutritional Status and Disease Staging

Nunes

Bassani

Fernandes

et al. 2016

Arq. Gastroenterol.

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“…Metabolic disorders, such as alterations in the metabolism of carbohydrates (insulin resistance); proteins, due to increased need and decreased absorption with reduction in hepatic synthesis; and fat, by lipolysis increase and lipid oxidation (34) , as well as hypermetabolism, which occurs in 16%-34% of patients with chronic hepatic disease (32,34) , can favor malnutrition development.…”

Section: Discussionmentioning

confidence: 99%

“…Although hemoglobin and hematocrit are independent from the hepatic metabolism, they can be altered in cases of severe portal hypertension followed by splenomegaly and hypersplenism, as well as in the presence of digestive bleeding (32) .…”

Section: Discussionmentioning

confidence: 99%

Biochemical Nutritional Profile of Liver Cirrhosis Patients With Hepatocellular Carcinoma

Port

Oliveira

Soldera

et al. 2014

Arq. Gastroenterol.

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-Context -Liver cirrhosis patients with hepatocellular carcinoma present nutritional alterations and metabolic disorders that negatively impact the prognosis. Objective -The objective is to identify alterations in the metabolism of macro and micronutrients among liver cirrhosis patients with and without hepatocellular carcinoma and their relation to the Child-Turcote-Pugh score and Barcelona Clinic Liver Cancer staging. Methods -Analytical transversal study, with 31 hepatocellular carcinoma patients and 48 liver cirrhosis patients. Laboratorial exams were carried out. The existence of an association between the biochemical parameters and the disease severity as well as the presence of hepatocellular carcinoma was assessed. Results -The metabolic-nutritional profile of liver cirrhosis patients caused by the hepatitis C virus and hepatocellular carcinoma showed alterations, specifically the lipid (total cholesterol, HDL and triglycerides), protein (albumin, creatinine and uric acid), iron (transferrin, iron and ferritin saturation), hematocrit and hemoglobin, zinc and B12 vitamin profiles. There is a relation between nutritional biochemical markers and the Child-Turcote-Pugh, as well as Barcelona Clinic Liver Cancer staging. Conclusion -Considering the existence of alterations in the metabolism of nutrients in liver cirrhosis patients with and without hepatocellular carcinoma, and also that conventional nutritional assessment methods present limitations for this population, the biochemical laboratorial exams are valid to complement the diagnosis of the nutritional state in a quick and practical manner.

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“…3,15,16 The use of the Maastricht index (MI) and the nutritional risk index (NRI) in the evaluation of liver disease patients are also suggested, in order to increase the sensitivity and specificity of nutritional diagnosis.…”

Section: -13mentioning

confidence: 99%

Nutritional Implications in Chronic Liver Diseases

Fortes¹

2017

JLRDT

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Abbreviations: SGA, subjective global assessment; MI, maastricht index; NRI, nutritional risk index; BMI, body mass index; ESPEN, european society for parenteral and enteral nutrition; NT, nutritional therapy; BCAA, branched-chain amino acids; AAA, aromatic amino acids; MNTT, multiprofessional nutritional therapy team Mini reviewChronic liver disease-an inflammatory reaction in the liver of variable etiology and severity, with a progressive evolution characterized by the presence of fibrosis and alteration of the normal hepatic structure-presents with great nutritional impact, since the liver is the organ responsible for several biochemical pathways related to the production, modification and use of nutrients, among other important metabolic substances. 1Early stage liver disease may be asymptomatic or with nonspecific symptoms such as fatigue, anorexia/hyporexia, fever and malaise, easily confused with other diseases. As the disease progresses, hepatic insufficiency and portal hypertension may present with a symptomatic picture characterized by ascites, gastric/esophageal veins hemorrhage and hepatic encephalopathy. Chronic liver failure represents a continuous aggression to the hepatic parenchyma and has a multifactorial etiology, such as alcoholism, viral infections and accumulation of cytoplasmic fat and/or autoimmune disease.3 When the disease is irreversible and symptomatic, the prospect of survival is less than one year and, in these cases, liver transplantation may be indicated, since there are no clinical and/or surgical therapeutic alternatives. 4 The high mortality rate is present in chronic liver failure in detriment of the reduced functional capacity of the liver that can exceed 80%, a condition characterized by liver failure. In addition, this insufficiency is associated with an increased risk of developing hepatic encephalopathy. 3Hepatic encephalopathy, a neuropsychiatric syndrome characterized by changes in personality, behavior, reduction of cognition, motor function and level of consciousness is potentially reversible. However, during this clinical situation, an unfavorable prognosis with a high mortality rate is observed. 2,3Changes in anthropometric, biochemical and clinical indicators, associated with inadequate food intake are common in chronic liver disease. Changes in water compartments-ascites and peripheral edema-related to hypoalbuminemia and malnutrition are also present in the decompensated disease.1,3 Other changes present in chronic liver diseases include those related to the Intermediary metabolism of carbohydrates, lipids, proteins, vitamins and minerals that oscillate according to the degree of impairment of liver function, which negatively influences the nutritional status of these patients. 1,3,5 Studies indicate that malnutrition is present in 20% to 80% of the patients with liver disease depending on the clinical stage of the disease. There is a high prevalence of malnutrition, especially in those with decompensated cirrhosis. Already, in patients on a liver transplant list...

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Avaliação nutricional no paciente cirrótico: uma abordagem objetiva, subjetiva ou multicompartimental?

Cited by 22 publications

References 19 publications

Food Consumption of Cirrhotic Patients, Comparison With the Nutritional Status and Disease Staging

Food Consumption of Cirrhotic Patients, Comparison With the Nutritional Status and Disease Staging

Biochemical Nutritional Profile of Liver Cirrhosis Patients With Hepatocellular Carcinoma

Nutritional Implications in Chronic Liver Diseases

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