The nature of malnutrition in children with end-stage liver disease awaiting orthotopic liver transplantation

Abstract

To evaluate malnutrition in chronic liver disease, and its relationship to nutrient deficiencies and hepatic dysfunction, 27 children with end-stage liver disease were studied. Mean protein-energy intakes were 70% of recommended daily intakes. The patients were underweight and stunted with reduced mean triceps and subscapular skinfold thicknesses and midupper arm circumference. Mean total body potassium was only 63 +/- 18% of that expected for age and sex. Deficiency of essential fatty acids (32%), and low concentrations of fat-soluble vitamins (A, 92%; E, 32%), iron (32%), zinc (42%), and selenium (13%) were common. Serum ammonia concentrations were raised in all patients, and increased methionine, tyrosine, and glutamic acid, and reduced glutamine concentrations were noted. There was no correlation between the degree of malnutrition and the degree of liver synthetic function, the degree of cholestasis, or the degree of liver injury. We suggest that potentially correctable factors in addition to liver failure (eg, inadequate absorbed intake) were important determinants of malnutrition in these patients.

Baixas concentrações plasmáticas de zinco em pacientes pediátricos com cirrose

“…9 This study found a significant plasma zinc deficiency (43%) in pediatric patients with liver cirrhosis when compared with normal control subjects in the same age group. The results of this study are compatible with those reported by Chin et al, 19 who evaluated the nutritional status of 27 children awaiting liver transplantation and found hypozincemia in 42% of the patients.…”

“…28 A positive association between supplementation and the increase in growth velocity in children was also observed by Nakamura et al 29 and by Michaelsen et al 30 Our study did not find any association between anthropometric data and plasma zinc concentrations, which is in agreement with other studies of pediatric patients with cirrhosis. 19,24 In a recent study that evaluated plasma zinc concentration in pediatric patients with cystic fibrosis, the body mass index was not correlated with low plasma zinc concentrations as well. 25 Trials of zinc supplementation have shown positive effects on clinical outcomes and growth, especially among children who are stunted.…”

Comparison of indices of vitamin A status in children with chronic liver disease

“…[2][3][4][5] Previous studies using a variety of indices of vitamin A status have suggested that 35% to 69% of children who have cholestatic liver disease may be vitamin A-deficient. 1,2,6,7 However, the accuracy of the indices used to assess vitamin A status in these studies has not been validated in children who have chronic liver disease. Measurement of adequate liver stores of vitamin A is one established way of determining if a patient is vitamin A-sufficient.…”

Estado nutricional e absorção intestinal de ferro em crianças com doença hepática crônica com e sem colestase

“…1 Severe proteinenergy malnutrition affects approximately 60% of children with chronic liver disease, [2][3][4][5] being secondary to the interaction of multiple factors, including reduced nutritional intake, intestinal malabsorption and increased nutrient requirements due to increased energy expenditure. 1,6,7 Despite the knowledge that an adequate nutritional status contributes towards successful liver transplantation and lower rates of postoperative complications, 5,[8][9][10][11][12] studies performed during transplant pre-op show that a large proportion of patients with chronic liver disease exhibit inadequate nutrient intake and protein-energy malnutrition. 6,12 Another common manifestation of chronic liver disease is anemia.…”

“…1,6,7 Despite the knowledge that an adequate nutritional status contributes towards successful liver transplantation and lower rates of postoperative complications, 5,[8][9][10][11][12] studies performed during transplant pre-op show that a large proportion of patients with chronic liver disease exhibit inadequate nutrient intake and protein-energy malnutrition. 6,12 Another common manifestation of chronic liver disease is anemia. The greater part of what is known about anemia in chronic liver disease comes from studies of patients with alcoholic cirrhosis.…”