Silva Luciana D, Bering Tatiana, Rocha Gifone A
aDepartment of Internal Medicine, Medical School bAmbulatory of Viral Hepatitis, Alfa Institute of Gastroenterology, Medical School cLaboratory of Research in Bacteriology, Medical School, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
Curr Opin Clin Nutr Metab Care. 2017 Sep;20(5):420-425. doi: 10.1097/MCO.0000000000000396.
The aim of this study was to review the most recent aspects of nutrition and its impact on health-related quality of life (HRQOL) in patients with chronic hepatitis C (CHC).
Low HRQOL scores have been found in all stages of hepatitis C virus (HCV) infection. Of the factors linked to HRQOL, three aspects should be emphasized, nutritional status, physical activity and mental health status. Regarding the nutrition and metabolic conditions, a broad spectrum of nutritional disorders may impact on HRQOL of patients with CHC.
Malnutrition, which is a significant comorbidity in end-stage of all chronic liver diseases, has been recognized as a significant factor related to poor HRQOL. Of note, in individuals chronically infected with HCV, low muscle skeletal mass, an early indicator of undernourishment, precedes the development of cirrhosis. Because of the strict linkage between HRQOL, nutrition and physical activity, the assessment of the musculoskeletal system abnormalities in every patient with CHC, independently of the stage of the liver disease, is of utmost relevance. Maintenance of healthy skeletal muscle is essential to reduce the negative effects of sarcopenia on HRQOL. Otherwise, overweight/obesity and chronic HCV infection can cause insulin resistance, which has been associated with HRQOL impairment.
本研究旨在回顾慢性丙型肝炎(CHC)患者营养的最新情况及其对健康相关生活质量(HRQOL)的影响。
在丙型肝炎病毒(HCV)感染的各个阶段均发现HRQOL得分较低。在与HRQOL相关的因素中,有三个方面应予以强调,即营养状况、身体活动和心理健康状况。关于营养和代谢状况,广泛的营养紊乱可能会影响CHC患者的HRQOL。
营养不良是所有慢性肝病终末期的一种重要合并症,已被认为是与HRQOL差相关的一个重要因素。值得注意的是,在慢性HCV感染者中,低肌肉骨骼质量作为营养不良的早期指标,先于肝硬化的发生。由于HRQOL、营养和身体活动之间存在紧密联系,因此对每一位CHC患者的肌肉骨骼系统异常进行评估(无论肝病处于何阶段)都至关重要。维持健康的骨骼肌对于减少肌肉减少症对HRQOL的负面影响至关重要。否则,超重/肥胖与慢性HCV感染可导致胰岛素抵抗,而这与HRQOL受损有关。