Food Science Post Graduation Program, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Surgery Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
JPEN J Parenter Enteral Nutr. 2021 Mar;45(3):456-464. doi: 10.1002/jpen.1985. Epub 2020 Aug 25.
Patients with end-stage liver disease (ESLD) and undergoing liver transplantation (LTx) commonly present with malnutrition attributed to various etiologies. One of the causes is potential hypermetabolism resulting from increased resting energy expenditure (REE). After the surgery, it is hypothesized that these patients show a reduction in REE, which may contribute to the weight gain observed in this population. However, there have been controversial results regarding the metabolic status of ESLD patients and liver recipients, which has led us to critically review the pertinent literature. We enrolled studies with the following goals: assessment of REE of these patients either before or after surgery by using indirect calorimetry (measured REE [mREE]) and comparison of these mREE values with those of healthy controls or with REE values obtained using predictive equations (predicted REE [pREE]). For most patients, mREE and pREE values were comparable. However, ≥5.3% of patients exhibited hypermetabolism when the mREE was compared with the pREE using the Harris-Benedict formula. Three follow-up studies that were conducted postsurgery showed a progressive reduction in the mREE for ≤1 year. However, conflicting data have been published, and cross-sectional studies have not reported hypometabolic patients. In conclusion, there is no consensus regarding the metabolic status of pre-LTx and post-LTx patients, which may be due to differences in the methods used for comparison. Therefore, we highlight this aspect of LTx patient management, which impacts the quality of nutrition therapy required by these patients.
终末期肝病（ESLD）患者在接受肝移植（LTx）时通常存在多种病因导致的营养不良。原因之一是潜在的高代谢，这是由静息能量消耗（REE）增加引起的。手术后，这些患者的 REE 减少，这可能是该人群体重增加的原因。然而，关于 ESLD 患者和肝移植受者的代谢状态存在争议，这促使我们对相关文献进行了批判性回顾。我们纳入了以下目标的研究：通过间接热量法（测量 REE [mREE]）评估这些患者手术前后的 REE，并将这些 mREE 值与健康对照组或使用预测方程（预测 REE [pREE]）获得的 REE 值进行比较。对于大多数患者，mREE 和 pREE 值是可比的。然而，当使用 Harris-Benedict 公式将 mREE 与 pREE 进行比较时，≥5.3%的患者表现出高代谢。三项术后随访研究表明，mREE 在≤1 年内逐渐降低。然而，发表的数据存在冲突，横断面研究并未报告低代谢患者。总之，关于术前和术后 LTx 患者的代谢状态尚未达成共识，这可能是由于比较方法的差异所致。因此，我们强调了这一方面的 LTx 患者管理，这会影响这些患者所需的营养治疗质量。
