Nunes Gonçalo, Santos Carla Adriana, Barosa Rita, Fonseca Cristina, Barata Ana Teresa, Fonseca Jorge
Hospital Garcia de Orta, Departamento de Gastroenterologia, GENE - Artificial Feeding Team, Almada, Portugal.
CiiEM, Centro de Investigação Interdisciplinar Egas Moniz, Monte da Caparica, Portugal.
Arq Gastroenterol. 2017 Jul-Sept;54(3):225-231. doi: 10.1590/S0004-2803.201700000-28. Epub 2017 Jul 6.
: Protein-calorie malnutrition is common in chronic liver disease (CLD) but adequate clinical tools for nutritional assessment are not defined.
: In CLD patients, it was aimed: 1. Characterize protein-calorie malnutrition; 2. Compare several clinical, anthropometric and functional tools; 3. Study the association malnutrition/CLD severity and malnutrition/outcome.
: Observational, prospective study. Consecutive CLD ambulatory/hospitalised patients were recruited from 01-03-2012 to 31-08-2012, studied according with age, gender, etiology, alcohol consumption and CLD severity defined by Child-Turcotte-Pugh. Nutritional assessment used subjective global assessment, anthropometry, namely body-mass index (BMI), triceps skinfold, mid upper arm circumference, mid arm muscular circumference and handgrip strength. Patients were followed during two years and survival data was recorded.
: A total of 130 CLD patients (80 men), aged 22-89 years (mean 60 years) were included. Most suffered from alcoholic cirrhosis (45%). Hospitalised patients presented more severe disease ( P <0.001) and worst nutritional status defined by BMI ( P =0.002), mid upper arm circumference ( P <0.001), mid arm muscular circumference ( P <0.001), triceps skinfold ( P =0.07) and subjective global assessment ( P <0.001). A third presented deficient/low handgrip strength. Alcohol consumption ( P =0.03) and malnutrition detected by BMI ( P =0.03), mid upper arm circumference ( P =0.001), triceps skinfold ( P =0.06), mid arm muscular circumference ( P =0.02) and subjective global assessment ( P <0.001) were associated with CLD severity. From 25 patients deceased during follow-up, 17 patients were severely malnourished according with triceps skinfold. Malnutrition defined by triceps skinfold predicted mortality ( P <0.001).
: Protein-calorie malnutrition is common in CLD patients and alcohol plays an important role. Triceps skinfold is the most efficient anthropometric parameter and is associated with mortality. Nutritional assessment should be considered mandatory in the routine care of CLD patients.
蛋白质 - 热量营养不良在慢性肝病（CLD）中很常见，但尚未确定用于营养评估的充分临床工具。
在CLD患者中，旨在：1. 描述蛋白质 - 热量营养不良；2. 比较几种临床、人体测量和功能工具；3. 研究营养不良与CLD严重程度以及营养不良与预后的关联。
观察性前瞻性研究。从2012年3月1日至2012年8月31日招募连续的CLD门诊/住院患者，根据年龄、性别、病因、饮酒情况以及由Child - Turcotte - Pugh定义的CLD严重程度进行研究。营养评估采用主观全面评定法、人体测量学，即体重指数（BMI）、三头肌皮褶厚度、上臂中部周长、上臂中部肌肉周长和握力。对患者进行两年随访并记录生存数据。
共纳入130例CLD患者（80例男性），年龄22 - 89岁（平均60岁）。大多数患者患有酒精性肝硬化（45%）。住院患者疾病更严重（P < 0.001），且根据BMI（P = 0.002）、上臂中部周长（P < 0.001）、上臂中部肌肉周长（P < 0.001）、三头肌皮褶厚度（P = 0.07）和主观全面评定法（P < 0.001）确定的营养状况更差。三分之一的患者握力不足/较低。饮酒（P = 0.03）以及通过BMI（P = 0.03）、上臂中部周长（P = 0.001）、三头肌皮褶厚度（P = 0.06）、上臂中部肌肉周长（P = 0.02）和主观全面评定法（P < 0.001）检测到的营养不良与CLD严重程度相关。在随访期间死亡的25例患者中，根据三头肌皮褶厚度，17例患者严重营养不良。由三头肌皮褶厚度定义的营养不良可预测死亡率（P < 0.001）。
蛋白质 - 热量营养不良在CLD患者中很常见，酒精起重要作用。三头肌皮褶厚度是最有效的人体测量参数，且与死亡率相关。在CLD患者的常规护理中应强制进行营养评估。
