Pinto Andressa S, Chedid Marcio F, Guerra Léa T, Cabeleira Daiane D, Kruel Cleber D P
Postgraduate Program in Surgical Sciences.
Division of Gastrointestinal Surgery and Liver and Pancreas Transplantation.
Arq Bras Cir Dig. 2016 Nov-Dec;29(4):246-251. doi: 10.1590/0102-6720201600040008.
Dyslipidemia occurs in approximately 70% of all liver transplant (LT) recipients, and no prior control studies have demonstrated any dietary intervention to change it.
To analyze the effects of a dietary intervention on the lipid profile of dyslipidemic LT recipients.
All LT recipients with dyslipidemia on clinical follow-up were enrolled. Anthropometric evaluation, food history, body composition (bioimpedance) and assessment of basal metabolism through indirect calorimetry were performed. Patients met with a dietitian and an individualized diet based on estimate of basal metabolism and consisting of 25% of the total energy value in total fat and <200 mg/day of cholesterol was prescribed. Total cholesterol (TC), HDL-cholesterol (HDL), LDL-cholesterol (LDL), triglycerides (TG) and anthropometric measures were measured at baseline and six months after intervention.
Fifty-thee out of 56 patients concluded follow-up; age was 59±10 years; 29 were men (51.8%). The analysis pre- and post-intervention were, respectively: TC 238.9±30 and 165.1±35, p<0.001; LDL 154±33 and 90±29, p<0.001; and TG 168 (IQR=51-200) and 137 (IQR=94-177), p=<0.001. They were all modified at six months following intervention. At baseline, none of the patients had normal TC, and only 12 (22.7%) had optimal/near optimal LDL. Following dietary intervention, 45 patients (84.9%) reached normal TC and 50 (94.4%) had optimal/near optimal LDL. HDL and anthropometric measures were not modified.
Dietary counseling with prescription of individualized diet based on estimate of basal metabolism through indirect calorimetry was able to manage dyslipidemia in most LT recipients; so, all dyslipidemic LT recipients must be enrolled on a dietary program.
约70%的肝移植受者会出现血脂异常，此前尚无对照研究表明任何饮食干预可改变这种情况。
分析饮食干预对血脂异常的肝移植受者血脂水平的影响。
纳入所有临床随访中存在血脂异常的肝移植受者。进行人体测量评估、饮食史调查、身体成分分析（生物电阻抗法）以及通过间接测热法评估基础代谢。患者与营养师会面，根据基础代谢估算制定个性化饮食方案，规定总脂肪占总能量值的25%且胆固醇摄入量<200毫克/天。在基线期和干预6个月后测量总胆固醇（TC）、高密度脂蛋白胆固醇（HDL）、低密度脂蛋白胆固醇（LDL）、甘油三酯（TG）以及人体测量指标。
56例患者中有53例完成随访；年龄为59±10岁；29例为男性（51.8%）。干预前后分析结果分别为：TC 238.9±30和165.1±35，p<0.001；LDL 154±33和90±29，p<0.001；TG 168（四分位间距=51 - 200）和137（四分位间距=94 - 177），p =<0.001。干预6个月后这些指标均有改善。基线期，无患者TC正常，仅12例（22.7%）LDL处于最佳/接近最佳水平。饮食干预后，45例患者（84.9%）TC恢复正常，50例（94.4%）LDL处于最佳/接近最佳水平。HDL和人体测量指标未改变。
通过间接测热法估算基础代谢并据此制定个性化饮食方案的饮食咨询能够使大多数肝移植受者的血脂异常得到控制；因此，所有血脂异常的肝移植受者都应参与饮食计划。
