Calmet Fernando, Martin Paul, Pearlman Michelle
Dr Calmet is a fellow, Dr Martin is a professor and the division chief, and Dr Pearlman is an assistant professor in the Division of Gastroenterology and Hepatology at the University of Miami Miller School of Medicine in Miami, Florida.
Gastroenterol Hepatol (N Y). 2019 May;15(5):248-254.
Malnutrition is a common complication of cirrhosis, increases in frequency with Child-Turcotte-Pugh (CTP) score, and is associated with an increased morbidity and mortality. Although malnutrition is easily recognized in chronically ill patients with CTP class C cirrhosis, it is present but often unrecognized in up to 50% of patients with CTP class A cirrhosis; thus, all patients with cirrhosis, regardless of etiology or severity, should be screened for malnutrition. A nutritional screening should be incorporated into the routine clinical care of patients with cirrhosis, with a more extensive nutritional assessment that includes a detailed history, dietary recall, baseline nutrition laboratory tests, and evaluation of sarcopenia using imaging modalities or strength testing to determine the degree of frailty. A thorough assessment will allow for a personalized treatment plan that provides the patient with total daily caloric intake goals with an emphasis on quality protein, education on timing of oral intake with a reduction in periods of fasting, identification and treatment of micronutrient deficiencies, and recommendation of safe and realistic exercise programs to help prevent and/or reduce sarcopenia and improve frailty.
营养不良是肝硬化的常见并发症，其发生率随Child-Turcotte-Pugh（CTP）评分增加而升高，且与发病率和死亡率增加相关。虽然营养不良在CTP C级肝硬化的慢性病患者中很容易识别，但在高达50%的CTP A级肝硬化患者中也存在但往往未被识别；因此，所有肝硬化患者，无论病因或严重程度如何，都应进行营养不良筛查。营养筛查应纳入肝硬化患者的常规临床护理中，同时进行更全面的营养评估，包括详细病史、饮食回顾、基线营养实验室检查，以及使用成像方式或力量测试评估肌肉减少症以确定虚弱程度。全面评估将有助于制定个性化治疗计划，为患者提供每日总热量摄入目标，重点是优质蛋白质，指导口服摄入时间以减少禁食期，识别和治疗微量营养素缺乏，并推荐安全可行的运动计划，以帮助预防和/或减少肌肉减少症并改善虚弱状况。
