Nutritional assessment in cirrhotic patients with hepatic encephalopathy

Abstract

Hepatic encephalopathy (HE) is one of the worst complications of liver disease and can be greatly influenced by nutritional status. Ammonia metabolism, inflammation and muscle wasting are relevant processes in HE pathophysiology. Malnutrition worsens the prognosis in HE, requiring early assessment of nutritional status of these patients. Body composition changes induced by liver disease and limitations superimposed by HE hamper the proper accomplishment of exams in this population, but evidence is growing that assessment of muscle mass and muscle function is mandatory due to the role of skeletal muscles in ammonia metabolism. In this review, we present the pathophysiological aspects involved in HE to support further discussion about advantages and drawbacks of some methods for evaluating the nutritional status of cirrhotic patients with HE, focusing on body composition.

Anthropometric changes caused by hepatitis C treatment with interferon and ribavirin: which patients and which measures are affected?

“…In addition, female patients had a more significant decrease in TSF thickness than males. Some prior studies with cirrhotic patients showed that MAMC is more affected in men than in women, whereas TSF thickness is expressively more reduced in women compared to men [13,21]. Since the sample had a significant amount of subjects with advanced liver fibrosis and TSF thickness was more affected than MAMC, the results were compatible with these prior studies.…”

“…Actually, even some modern methods can be affected by fluid retention in these patients, such as bioimpedance analysis (BIA) and dual-energy X-ray absorptiometry [13]. Hence, anthropometry is still a valuable technique of body composition assessment in this population, because some measures are less influenced by fluid imbalance.…”

Outcome and Nutritional Assessment of Chronic Liver Disease Patients Using Anthropometry and Subjective Global Assessment

“…On the other hand, dynamometry was not used to assess functional status in all patients, as the necessary equipment was not available during the all period of the study. Also, more sophisticated methods like bioimpedance and indirect calorimetry that are emerging in several institutions (7,20) were not applied in these study, as they are not available in most of Portuguese health centres. Nevertheless, the study highlights the importance of considering clinical and anthropometric data to screen and assess nutritional status in CLD patients showing its accuracy in detecting malnutrition especially using TSF and SGA.…”

“…Classic anthropometric parameters such as weight and Body Mass Index (BMI) are often overestimated by ascites and tissue oedema. Skinfold thickness (bicep, triceps or subscapular) and mid upper arm circumference (MUAC) are less 226 • Arq Gastroenterol • 2017. v. 54 nº 3 Jul/Set influenced by patient fluid status and despite the possibility of inter-observer variability, these measures are considered to be more sensitive than BMI to detect malnutrition in CLD patients (13,20,26) . Laboratory parameters such as albumin and other serum proteins are unreliable as true nutritional status markers and its low serum concentration is associated with severity of liver disease and degree of inflammation (13,23) .…”

The Challenges of Nutritional Assessment in Cirrhosis

“…However, functional measures, in particular the 6-minute walk test and other tests requiring walking or attentive participation, cannot be performed correctly in patients with complications of portal hypertension (i.e. encephalopathy) [38]. Handgrip strength appears to be a valuable option and it consists in an easy-to-perform method that can diagnose or predict sarcopenia with an overall higher sensitivity and specificity with respect to other tools, thus representing a predictor of complications and decompensation in cirrhosis [39].…”