Factors influencing malnutrition in children waiting for liver transplants

Abstract

Nutrition deficiencies are common in children with chronic liver disease. To determine whether age, hepatic dysfunction, or energy intake influences this malnutrition, we evaluated the nutritional status of 49 children aged 2.5 mo to 13 y (mean: 35 mo; median: 12 mo). The children were divided into two groups according to age: group 1-29 patients aged < or = 1 y (mean: 7 mo; median: 7 mo); and group 2-20 patients > 1 y (mean: 75 mo; median: 59 mo). Hepatic dysfunction was defined according to the Malatack criteria. Seventy-two-hour dietary intakes were recorded by a nutritionist. Nutritional status was assessed by anthropometric measures when the patients were enrolled on the waiting list for liver transplants. We evaluated the following indexes: weight, height, fat body mass, and lean body mass on the basis of height-age (age at which height reached 50th Italian height percentile). Mean height Z scores were low in both groups, but the difference was not significant. Mean weight Z scores and mean percentages of fat body mass were significantly lower (P < 0.001) in group 1 than in group 2 patients. In group 2, lean body mass and fat body mass were significantly lower (P < 0.05) in patients with moderate-to-severe hepatic failure than in patients with mild hepatic dysfunction. The mean energy intake was in the range of the recommended daily allowances for age but was insufficient for both groups of patients. The evidence of significant acute and chronic malnutrition confirmed the need for nutritional support, especially for younger and older children with moderate-to-severe hepatic dysfunction. We emphasize the necessity of accurate assessment of nutritional status by simple anthropometric measurements to be sure of the effects and adequacy of the nutritional intervention.

Cirrhosis in children and adolescents: An overview

“…In children and adolescents, the increased energy demands associated with anorexia and nausea may complicate the management of malnutrition [64][65][66] . A comprehensive clinical history and general physical examinations of the child/adolescent must be included in routine clinical practice [67] , and special attention must be paid to changes in muscle mass and body fat depots, both of which reflect important aspects of patient nutritional status.…”

Management of the pediatric liver transplant patient

“…A variety of metabolic and endocrine perturbations that decrease peripheral calorie utilization have been described. [4][5][6][7][8] Managing malnutrition in the setting of end-stage liver disease is a challenge. Although the first step is to increase the caloric density of the formula (for infants, this is seldom sufficient alone), nighttime drip feedings through either a nasogastric or nasojejunal tube may be successful in some children who can tolerate the additional volume of feedings without increasing either ascites or emesis.…”

Determinação de risco nutricional e desnutrição por antropometria em crianças e adolescentes com cirrose

“…A medida de CMB estima a reserva protéica e a PCT a reserva de gordura. A PCT é uma medida que apresenta boa correlação com a reserva adiposa corporal e em conjunto com a CMB, são métodos sensíveis a mudanças no estado nutricional (23,27,32) . Estes parâmetros são menos influenciáveis pelas manifestações clínicas das hepatopatias (31) .…”

“…Alguns pacientes, apresentaram valores de P/I dentro da normalidade e PCT diminuído, o que demonstra que o acompanhamento desta medida pode indicar precocemente o risco nutricional. Outros estudos (27,31) , também observaram que medidas que estimam reservas calóricas e protéicas se encontram mais deprimidas do que outros parâmetros nutricionais nos hepatopatas. Vários fatores contribuem para a desnutrição calórico-protéica e deficiências de vitaminas e minerais na cirrose (29) : a ingestão pode ser insuficiente devido à anorexia, náuseas, vômitos, saciedade precoce, mudanças de paladar provocadas por medicamentos ou por distúrbios bioquímicos e também por causa de dificuldades comportamentais em relação à alimentação; os comprometimentos da digestão e absorção podem ser ocasionados por redução do fluxo biliar, causando a má absorção de gorduras, vitaminas lipossolúveis e deficiência de ácidos graxos essenciais e pela enteropatia devido à hipertensão portal.…”