Mouzaki Marialena, Ng Vicky, Kamath Binita M, Selzner Nazia, Pencharz Paul, Ling Simon C
Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto Department of Paediatrics, University of Toronto, Toronto
Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto Department of Paediatrics, University of Toronto, Toronto.
JPEN J Parenter Enteral Nutr. 2014 Aug;38(6):673-81. doi: 10.1177/0148607114522488. Epub 2014 Feb 14.
Protein-energy malnutrition is the most common comorbidity affecting adults and children with end-stage liver disease. Despite clear evidence linking malnutrition to poor outcomes before and after liver transplantation, nutrition rehabilitation is often inadequately emphasized in the clinical management of these patients. The primary aim of this review is to synthesize the available evidence supporting the current clinical guidelines on enteral nutrition support and, more important, to highlight the lack of evidence behind much of what is considered "standard of care" for the nutrition management of patients with cirrhosis. In addition, the mechanisms of malnutrition are reviewed, the limitations of tools used to assess body composition in this setting are discussed, and the differences in macronutrient metabolism between healthy subjects and patients with end-stage liver disease are explained. A summary of recommendations is provided.
蛋白质 - 能量营养不良是影响终末期肝病成人和儿童的最常见合并症。尽管有明确证据表明营养不良与肝移植前后的不良预后相关，但在这些患者的临床管理中，营养康复往往未得到充分重视。本综述的主要目的是综合现有证据以支持当前关于肠内营养支持的临床指南，更重要的是，强调在肝硬化患者营养管理的许多被视为“护理标准”的措施背后缺乏证据。此外，还回顾了营养不良的机制，讨论了在此情况下用于评估身体成分的工具的局限性，并解释了健康受试者与终末期肝病患者在宏量营养素代谢方面的差异。最后提供了建议总结。
