Enteral nutrition in severely malnourished and anorectic cirrhotic patients in clinical practice

Determining the frequency and severity of malnutrition and correlating it with the severity of liver cirrhosis

“…Contributing factors include inadequate dietary intake, impaired digestion and absorption, and altered metabolism. Anorexia, nausea, encephalopathy, gastropathy, ascites, and concurrent alcohol consumption can all contribute to a reduction in dietary intake (6). Malabsorption and maldigestion of nutrients can also result from bile salts deficiency, altered intestinal motility, bacterial overgrowth, mucosal injury, portal hypertensive changes to the intestine, and increased intestinal permeability (7)(8)(9).…”

“…Assessment of malnutrition in everyday clinical practice is therefore quite difficult and challenging because of the objectivity of the methods used and the tendency of fluid retention (ascites) in cirrhosis of liver which may alter the results (2). Therefore, different parameters like phase angle or body mass cell measurement by bioelectric impedance analysis (BIA) to assess the nutritional status have been used and evaluated where some of them are quite useful and easy to perform and do not require high expertise (6,11).…”

Immune Alterations in Liver Cirrhosis: Its Relationship with Etiology,Child Pugh Stage and Malnutrition

“…Energy undernourishment in its diverse forms including the subclinical, compromises the resistance to external agents such as bacteria, viruses, fungus and also chemical agents in a severe way [8]. The recovery of immune functions after a nutritional substitution with supplements is encouraging and is another proof of the relationship between nutrition and immune state [9][10][11][12][13]. Cirrhotic patients have an increased intestinal permeability which enables the passage of endotoxins generated by gram negative bacteria from the intestine to the lymphatic and blood stream.…”

Avaliação dos indicadores nutricionais e da composição corporal em hepatopatas crônicos e a relação com a etiologia e gravidade da doença

“…(91) É considerada fator de risco para morbidade e mortalidade a curto e longo prazo (15,69,81,92) , no pré e pós transplante e nas cirurgias abdominais. (92,93) Estudo recente, realizado por Sam & Nguyen (2009) (81) demonstrou a associação de DCP com maior tempo de internação (8,7 dias versus 5,7 dias, p<0,0001), maior mortalidade intra-hospitalar e com maior índice de reinternações.…”

“…Esta depleção no tecido muscular pode estar relacionada ao efeito direto do álcool sobre o metabolismo do músculo esquelético. (32,93) Carvalho & Parise (2006) (107) (114) . A relação da etiologia com a gravidade pode estar associada à maior prevalência de ascite, encefalopatia hepática e HDA neste grupo de pacientes.…”