Nutritional assessment and adequacy of dietary intake in hospitalized patients with alcoholic liver cirrhosis

Nielsen, K.; Kondrup, Jens; Martinsen, L.; Stilling, B.; Wikman, Berit

doi:10.1079/bjn19930068

Cited by 105 publications

(72 citation statements)

References 37 publications

(30 reference statements)

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“…In the present study, mean protein-energy intake, when corrected for unit of ideal weight, did not satisfy the nutritional requirements of these patients which are 45 kcal and 1.5 g protein (5,18,26,29) . In patients with moderate and severe PCM, mean protein intake did not reach 70% of the patients' requirements.…”

Section: Discussioncontrasting

confidence: 77%

“…As also done by others (19,20,23,24) we decided to assign to a single group all patients with a history of alcoholism. In addition, all of these patient were heavy drinkers consuming large doses of alcohol which can cause PCM of themselves, as extensively demonstrated in the literature (15,22,24,29) . On the other hand, the results obtained after excluding these patients did not differ signifi cantly from those obtained for the group as a whole.…”

Section: Discussionmentioning

confidence: 58%

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Evaluation of nutritional status of nonhospitalized patients with liver cirrhosis

Carvalho

Parise

2006

Arq. Gastroenterol.

121

107

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-Background -Protein-calorie malnutrition is a frequent fi nding in patients with chronic liver disease, but investigations of nutritional status have been rarely performed in individuals seen at outpatient clinics. Aim -To evaluate the nutritional status of patients with alcoholic and nonalcoholic cirrhosis, attended for the fi rst time at a reference outpatient clinic for liver diseases. Patients and methods -A total of 300 consecutive patients attended at the outpatient clinics of a reference center for liver diseases were investigated. Anthropometric evaluation was performed by the usual parameters: triceps skinfold, arm circumference and arm muscle circumference. Biochemical parameters included creatinine/height index, serum albumin and lymphocytes count. The nutritional diagnosis was based on the PCM score proposed by Mendenhall et al. Food intake was retrospectively evaluated using 24-hour dietary recall data. Results -About 71% of the patients studied were chronic alcohol abusers, whereas in 29% cirrhosis was of nonalcoholic etiology. Independently of the disease etiology 75.3% of the patients showed some degree of protein-calorie malnutrition, which was moderate or severe in 38.3% of them. More advanced protein-calorie malnutrition degrees were associated with lower energy and protein intake. The prevalence of moderate or severe protein-calorie malnutrition was higher in patients classifi ed as Child-Pugh C than in patients classifi ed as Child-Pugh A (21% x 58%, respectively). Regarding sexual differences, fat reserves, evaluated by triceps skinfold, were more depleted in females than in males (48.6% x 26.6%) regardless of the etiology of the cirrhosis, whereas muscle reserves (arm muscle circumference) were more depleted in males (43.4% x 13.4%) regardless of the etiology of cirrhosis. In contrast, cirrhosis of alcoholic etiology was determinant in reducing arm muscle circumference in females (20% x 9.1%).Conclusions -These data highlight the high prevalence of protein-calorie malnutrition occurring early in the natural history of the disease and accompanying functional hepatic deterioration. In addition, attention should be paid to the different gender patterns of response to protein-calorie malnutrition in these patients. HEADINGS -Nutritional status. Liver cirrhosis. Outpatients.

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Section: Discussioncontrasting

confidence: 77%

Section: Discussionmentioning

confidence: 58%

Evaluation of nutritional status of nonhospitalized patients with liver cirrhosis

Carvalho

Parise

2006

Arq. Gastroenterol.

121

107

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“…Detailed studies have been undertaken on protein and nitrogen balance in these patients and consistent increases in their requirements clearly demonstrated. [12][13][14][15] However, there is no consensus in the data on energy expenditure, and thus energy requirements, in this patient population. [16][17][18][19][20][21][22] Plauth et al 23 recommended that energy requirements should be determined in patients with cirrhosis by measurement of their resting energy expenditure (REE) using indirect calorimetry.…”

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confidence: 99%

Resting energy expenditure should be measured in patients with cirrhosis, not predicted

Madden

Morgan

1999

Hepatology

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MeasurementsPatients with cirrhosis are frequently malnourished, 1-3 and this may have a detrimental effect on outcome. 4-7 Adequate nutritional support must be provided if the outlook for these patients is to be optimized, [8][9][10][11] but this requires a knowledge of their nutrient requirements. Detailed studies have been undertaken on protein and nitrogen balance in these patients and consistent increases in their requirements clearly demonstrated. 12-15 However, there is no consensus in the data on energy expenditure, and thus energy requirements, in this patient population. [16][17][18][19][20][21][22] Plauth et al. 23 recommended that energy requirements should be determined in patients with cirrhosis by measurement of their resting energy expenditure (REE) using indirect calorimetry. They suggest, but do not advocate, that if the facilities for measurement are not available, then energy expenditure could be estimated by use of the Harris-Benedict prediction formulae. 24 However, it has been shown that these formulae may underestimate mean measured values of REE in patients with cirrhosis by up to 13%, 17,18,[25][26][27][28][29][30][31][32][33] though presently, it is unclear whether this discrepancy is equally evident in all population subgroups.A number of alternative prediction formulae are available, 34-39 but the accuracy of the REE estimates derived from these has not been studied systematically in patients with chronic liver disease. A prediction formula developed specifically for use in this patient population, which incorporated a measure of fat-free mass (FFM) derived using bioelectrical impedance analysis, has been proposed by Mü ller et al. 40 but this has not been validated.The aims of this study were, therefore: 1) to compare values for REE predicted using the Harris-Benedict, 24 Schofield, 36 Mifflin, 39 Cunningham, 35 and Owen 37,38 formulae with measured values in both patients with cirrhosis and a comparable group of healthy volunteers; 2) to compare values for REE predicted using the ''disease-specific'' Mü ller 40 formula with measured values in patients with cirrhosis; 3) to determine if the predictions made in the patients with cirrhosis are adversely affected by malnutrition, fluid retention, the etiology of the liver injury, or the degree of hepatic decompensation; and 4) to derive an equation for predicting REE in this patient population and to assess its validity. PATIENTS AND METHODSThe patient population comprised 56 men and 44 women, with a mean (range) age of 48.5 (26-71) years, with cirrhosis of varying etiology and severity. The etiology of the liver injury was determined using historical, clinical, laboratory, radiological, and histological variables, while the functional severity of the liver disease was assessed using Pugh' s modification of Child' s grading system 41 (Table 1). Fifty-nine patients were assessed as in-patients, while the remaining 41 were assessed as out-patients. All patients with alcohol-related cirrhosis had been abstinent from alcohol for periods ra...

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“…[2][3][4] Irrespective of the possible effects of impaired renal or liver function, many studies have applied the creatinine-method for the assessment of malnutrition in cirrhosis. [5][6][7][8][9][10][11] clinical conditions covering all degrees of liver and renal func-24-hour urinary creatinine excretion was compared with predicted values based on a creatinine coefficient of 23 mg/kg ideal body weight for men and of 17 mg/kg ideal body weight for women according to Bistrian. 33 For patients older than 54 years, decreased values by 10% per decade were taken as recommended previously.…”

Section: Megx-test Cholines-mentioning

confidence: 99%

“…[2][3][4] Irrespective of the possible effects of impaired renal or liver function, many studies have applied the creatinine-method for the assessment of malnutrition in cirrhosis. [5][6][7][8][9][10][11] clinical conditions covering all degrees of liver and renal func- Received November 27, 1995; accepted August 2, 1996. tion to assess possible systematic errors associated with the Supported by generous grants given by B. Braun, …”

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confidence: 99%

The creatinine approach to estimate skeletal muscle mass in patients with cirrhosis

et al. 1996

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muscle mass. [2][3][4] The 24-hour urinary creatinine approach and The creatinine-method to estimate muscle mass is frethe anthropometric estimation of whole body skeletal muscle quently used in clinical studies, although the validity of mass are the most common methods, and the creatininethis approach is uncertain in patients with cirrhosis. In method has been proposed for the use in clinical studies. 5-11 this study 102 patients with cirrhosis differing in cause,The validity of the creatinine approach is uncertain in circlinical state, liver, and renal function were investigated rhosis, because creatine is synthesized in the liver by transto determine whether reduced liver or renal function methylation of guanidinoacetic acid (Fig. 1). 12 It has been may explain in part the low levels of urinary creatinine suggested that reduced liver function rather than reduced excretion frequently observed in these patients. Muscle muscle mass may explain the low levels of urinary creatinine mass assessed by 24-hour urinary creatinine excretion excretion frequently observed in these patients. 3,4 However, was compared with anthropometrically obtained muscle because the rate-limiting biosynthetic step of the creatine mass calculated from arm muscle area (AMA), and with precursor, guanidinoacetic acid, is predominantly located in body cell mass (BCM) estimated by bioelectrical impedthe kidney, 13 reduced liver function may not affect the validance analysis and total body potassium counting. In cirity of the creatinine approach in patients with cirrhosis. rhosis, the 24-hour urinary creatinine excretion wasTo determine the validity of the creatinine-muscle mass 10.4% and AMA was 19% lower than predicted values.method in cirrhosis we used anthropometry as a second comThe differences between the results obtained by differparative method. Anthropometrically obtained muscle mass ent methods did not show any relation to parameters of is based on a pars pro toto approach extrapolating from midliver function (ICG-t 1 2 , caffeine-t 1 2 , MEGX-test, cholinesarm circumference and triceps skinfold thickness. The preciterase) or the severity of liver disease (i.e., Child-Pugh sion and accuracy of skinfold measurements are good if perscore). In contrast, renal function was strongly correformed by skilled investigators. 14 In addition, the results of lated with the differences between creatinine-and anmuscle mass estimation were compared with body cell mass thropometric-muscle mass (r Å .64, P õ .001). At the same (BCM) assessed by total body potassium counting and biotime, patients with normal renal function (62% of the electrical impedance analysis (BIA) considering the fact that whole population) had significantly higher creatinine skeletal muscle mass represents about 80% of BCM. 15 BIA is (29.1 { 8.5 vs. 15.8 { 6 kg, P õ .001) and anthropometricwidely applied in clinical practice, and has a high precision muscle mass (22.4 { 6 vs. 17.9 { 5.3 kg; P õ .01) than (coefficient of variation õ 5%). 16,17 The value of the BIA appatients with ...

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Nutritional assessment and adequacy of dietary intake in hospitalized patients with alcoholic liver cirrhosis

Cited by 105 publications

References 37 publications

Evaluation of nutritional status of nonhospitalized patients with liver cirrhosis

Evaluation of nutritional status of nonhospitalized patients with liver cirrhosis

Resting energy expenditure should be measured in patients with cirrhosis, not predicted

The creatinine approach to estimate skeletal muscle mass in patients with cirrhosis

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