Ney Michael, Abraldes Juan G, Ma Mang, Belland Dawn, Harvey Andrea, Robbins Sarah, Den Heyer Vanessa, Tandon Puneeta
Cirrhosis Care Clinic, Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
Cirrhosis Care Clinic, Division of Gastroenterology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada Liver Transplant Unit, University of Alberta, Edmonton, Alberta, Canada.
Nutr Clin Pract. 2015 Aug;30(4):530-6. doi: 10.1177/0884533614567716. Epub 2015 Feb 9.
For patients awaiting liver transplantation, we aimed to determine the prevalence and predictors of insufficient protein intake as well as to determine whether very low protein intake was an independent predictor of malnutrition and mortality.
Adults with cirrhosis who were activated on our local liver transplant waiting list between January 2000 and October 2009 were included. Estimated protein intake was derived from dietary records. Patients with incomplete dietary records were excluded. Multivariable logistic regression and competing risk analysis were used.
Of 742 potential patients, 112 were excluded due to insufficient data, leaving 630 patients for evaluation. Mean protein intake was 1.0 ± 0.36 g/kg/d and only 24% of patients met the expert consensus recommended threshold of > 1.2 g/kg of protein per day. Very low protein intake (< 0.8 g/kg/d) was associated with worse liver disease severity (as measured by Child-Pugh or MELD). Protein intake below 0.8 g/kg/d was an independent predictor both of malnutrition as measured by the subjective global assessment (adjusted odds ratio [95% confidence interval (CI)]: 2.0 [1.3-3.0]) and of transplant waiting list mortality (adjusted hazard ratio [95% CI]: 1.8 [1.2-2.7]).
In this large cohort of liver transplant waitlisted patients, very low protein intake was prevalent and independently associated with malnutrition and mortality. Unlike many other prognostic factors, protein intake is potentially modifiable. Prospective studies are warranted to evaluate the effect of targeted protein repletion on clinically relevant outcomes such as muscle mass, muscle function, immune function, and mortality.
对于等待肝移植的患者，我们旨在确定蛋白质摄入量不足的患病率及其预测因素，并确定极低的蛋白质摄入量是否是营养不良和死亡率的独立预测因素。
纳入2000年1月至2009年10月在我们当地肝移植等候名单上被激活的肝硬化成年患者。估计的蛋白质摄入量来自饮食记录。饮食记录不完整的患者被排除。采用多变量逻辑回归和竞争风险分析。
在742名潜在患者中，112名因数据不足被排除，剩余630名患者进行评估。平均蛋白质摄入量为1.0±0.36 g/kg/天，只有24%的患者达到专家共识推荐的阈值，即每天蛋白质摄入量>1.2 g/kg。极低的蛋白质摄入量（<0.8 g/kg/天）与更严重的肝病严重程度相关（通过Child-Pugh或MELD评分衡量）。蛋白质摄入量低于0.8 g/kg/天是主观全面评定法所衡量的营养不良的独立预测因素（校正比值比[95%置信区间（CI）]：2.0[1.3 - 3.0]），也是移植等候名单上死亡率的独立预测因素（校正风险比[95%CI]：1.8[1.2 - 2.7]）。
在这一大型肝移植等候名单患者队列中，极低的蛋白质摄入量普遍存在，且与营养不良和死亡率独立相关。与许多其他预后因素不同，蛋白质摄入量具有潜在的可调节性。有必要进行前瞻性研究，以评估针对性补充蛋白质对肌肉量、肌肉功能、免疫功能和死亡率等临床相关结局的影响。
