Ruiz-Margáin A, Méndez-Guerrero O, Román-Calleja B M, González-Rodríguez S, Fernández-Del-Rivero G, Rodríguez-Córdova P A, Torre A, Macías-Rodríguez R U
Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
Rev Gastroenterol Mex (Engl Ed). 2018 Oct-Dec;83(4):424-433. doi: 10.1016/j.rgmx.2018.05.006. Epub 2018 Oct 3.
One of the most important characteristics of malnutrition is the loss of muscle mass and the severe depletion of the protein reserve, secondarily affecting energy metabolism. That impacts nutritional status and the progression of disease-related complications. Nutritional treatment is one of the main factors in the comprehensive management of those patients. Achieving adequate energy intake that provides the macronutrients and micronutrients necessary to prevent or correct malnutrition is attempted through dietary measures. ESPEN, the European Society for Clinical Nutrition and Metabolism, recommends a caloric intake of 30-40kcal/kg/day, in which carbohydrates provide 45-60% of the daily energy intake and proteins supply 1.0-1.5g/kg/day. The remaining portion of the total energy expenditure should be covered by lipids. The administration of branched-chain amino acids has been shown to be beneficial not only in counteracting malnutrition, but also as a coadjuvant treatment in specific complications, thus playing a favorable role in outcome and quality of life. Therefore, branched-chain amino acids should be considered part of nutritional treatment in patients with advanced stages of cirrhosis of the liver, particularly in the presence of complications.
营养不良最重要的特征之一是肌肉量减少和蛋白质储备严重消耗，继而影响能量代谢。这会影响营养状况以及疾病相关并发症的进展。营养治疗是这些患者综合管理的主要因素之一。通过饮食措施试图实现充足的能量摄入，以提供预防或纠正营养不良所需的宏量营养素和微量营养素。欧洲临床营养与代谢学会（ESPEN）建议热量摄入为30 - 40千卡/千克/天，其中碳水化合物提供每日能量摄入的45 - 60%，蛋白质供应1.0 - 1.5克/千克/天。总能量消耗的其余部分应由脂质提供。已证明给予支链氨基酸不仅有利于对抗营养不良，而且作为特定并发症的辅助治疗，从而对结局和生活质量发挥有利作用。因此，支链氨基酸应被视为晚期肝硬化患者营养治疗的一部分，特别是在存在并发症的情况下。
