Nutritional assessment in patients with cirrhosis

Fernandes, Sabrina Alves; Bassani, Lílian; Nunes, Flavia Feijó; Aydos, Maria Eugênia Deutrich; Alves, Alexandro Vaesken; Marroni, Cláudio Augusto

doi:10.1590/s0004-28032012000100005

Cited by 83 publications

(97 citation statements)

References 30 publications

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“…So far, there is no defined gold-standard for nutritional assessment in liver cirrhosis patients, and the studies that assess biochemical nutritional alterations in liver cirrhosis patients are still few (8) .…”

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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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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“…Tissues with a greater amount of water, due to the dissolution in electrolytes, are the major pathways of electric conduction, while body fat and bones are considered to be worse conductors. 7 A low alternating electrical current is conducted through a pair of electrodes while another pair, in which impedance is measured, measures the fall in tension.…”

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confidence: 99%

“…The PA reflects the relative contribution of fluid (resistance) and cell membranes (capacitance) of the human body. 7 Lean and fat body mass can be calculated. Lean mass is proportional to the amount of water, considering a 53.2% water constant in lean mass.…”

mentioning

confidence: 99%

“…However, the PA has been used as a prognostic marker in various clinical conditions in which the integrity of the cell membrane is compromised and changes in fluid balance are observed, such as the malnutrition of advanced neoplastic diseases. 7 This measure has several advantages such as being independent of regression equations and the fact that it can be calculated even in situations in which it is not possible to estimate body composition. 7 In a recent study, Fernandes et al 7 found that the PA is the only parameter for nutritional assessment that is correlated with the severity of hepatic disease assessed by the CP classification and emphasized the importance of establishing a cut-off point as a parameter for the classification of malnutrition in the population of cirrhotic patients.…”

mentioning

confidence: 99%

“…7 This measure has several advantages such as being independent of regression equations and the fact that it can be calculated even in situations in which it is not possible to estimate body composition. 7 In a recent study, Fernandes et al 7 found that the PA is the only parameter for nutritional assessment that is correlated with the severity of hepatic disease assessed by the CP classification and emphasized the importance of establishing a cut-off point as a parameter for the classification of malnutrition in the population of cirrhotic patients. 7 Thus, the interest in comparing the PA to other methods used for the nutritional assessment of cirrhotic patients is clearly justified, in order to obtain data about its performance as an indicator of the nutritional status of these patients.…”

mentioning

confidence: 99%

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Avaliação nutricional do paciente cirrótico: Uma nova abordagem através da bioimpedância elétrica

Balbino

Silva

2012

Medicina (Ribeirão Preto)

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The nutritional management of hepatic encephalopathy in patients with cirrhosis: International society for hepatic encephalopathy and nitrogen metabolism consensus

Amodio¹,

Bémeur²,

Butterworth³

et al. 2013

Hepatology

334

316

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Nitrogen metabolism plays a major role in the development of hepatic encephalopathy (HE) in patients with cirrhosis. Modulation of this relationship is key to the management of HE, but is not the only nutritional issue that needs to be addressed. The assessment of nutritional status in patients with cirrhosis is problematic. In addition, there are significant sex-related differences in body composition and in the characteristics of tissue loss, which limit the usefulness of techniques based on measures of muscle mass and function in women. Techniques that combine subjective and objective variables provide reasonably accurate information and are recommended. Energy and nitrogen requirements in patients with HE are unlikely to differ substantially from those recommended in patients with cirrhosis per se viz. 35-45 kcal/g and 1.2-1.5g/kg protein daily. Small meals evenly distributed throughout the day and a late-night snack of complex carbohydrates will help minimize protein utilization. Compliance is, however, likely to be a problem. Diets rich in vegetables and dairy protein may be beneficial and are therefore recommended, but tolerance varies considerably in relation to the nature of the staple diet. Branched chain amino acid supplements may be of value in the occasional patient intolerant of dietary protein. Increasing dietary fiber may be of value, but the utility of probiotics is, as yet, unclear. Short-term multivitamin supplementation should be considered in patients admitted with decompensated cirrhosis. Hyponatremia may worsen HE; it should be prevented as far as possible and should always be corrected slowly. Conclusion: Effective management of these patients requires an integrated multidimensional approach. However, further research is needed to fill the gaps in the current evidence base to optimize the nutritional management of patients with cirrhosis and HE. (HEPATOLOGY 2013;58:325-336) M alnutrition and hepatic encephalopathy (HE) are two of the most common complications of cirrhosis and both have detrimental effects on outcome.

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Nutritional assessment in patients with cirrhosis

Cited by 83 publications

References 30 publications

Biochemical Nutritional Profile of Liver Cirrhosis Patients With Hepatocellular Carcinoma

Biochemical Nutritional Profile of Liver Cirrhosis Patients With Hepatocellular Carcinoma

Avaliação nutricional do paciente cirrótico: Uma nova abordagem através da bioimpedância elétrica

The nutritional management of hepatic encephalopathy in patients with cirrhosis: International society for hepatic encephalopathy and nitrogen metabolism consensus

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