Soporte nutricional en el paciente con cirrosis hepática

Nutrition in Chronic Liver Disease

“…Multiple factors contribute to malnutrition in CLD, including anorexia, inefficient digestion/absorption, iatrogenic measures or impaired metabolism. 4 …”

“… 19 , 20 Heavy alcohol intake may also lead to a decreased appetite. 4 Cirrhotic patients may also have an impaired digestion/absorption, often caused by the presence of portal hypertension that promotes changes in the intestinal mucosa, like increased permeability, contributing to an increased loss of proteins (protein loss can also occur due to bleeding from ulcers or varices). 21 , 22 , 23 The deficiency of biliary salts (particularly in cholestatic diseases) and advanced degrees of pancreatic insufficiency (particularly in alcoholic disease) can cause steatorrhea, decreasing the absorption of certain nutrients.…”

“… 21 , 22 , 23 The deficiency of biliary salts (particularly in cholestatic diseases) and advanced degrees of pancreatic insufficiency (particularly in alcoholic disease) can cause steatorrhea, decreasing the absorption of certain nutrients. 4 , 5 Intestinal dysmotility and bacterial overgrowth may also lead to an impaired digestion/absorption. 24 …”

“…The studies report contradictory results; some claim that up to 34% of patients have a Rest Energy Expenditure (REE) of 120% above the expected value, 25 while in other studies, the patient's majority had a normal REE. 4 There are also changes in nutrients metabolism. Up to 70% of cirrhotic patients have some degree of glucose intolerance or insulin resistance, and between 14 and 40% have type II Diabetes mellitus.…”

“… 1 , 2 , 3 Malnutrition develops at an early stage of liver disease and there is, almost, a direct relationship between the severity of liver disease and the degree of malnutrition. 4 , 5 …”