Department of Clinical Medical Nutrition, University Hospital Graz, 8036 Graz, Austria.
Department of Gastroenterology and Hepatology, Medical University of Graz, 8036 Graz, Austria.
Nutrients. 2021 Feb 7;13(2):540. doi: 10.3390/nu13020540.
Liver cirrhosis is an increasing public health threat worldwide. Malnutrition is a serious complication of cirrhosis and is associated with worse outcomes. With this review, we aim to describe the prevalence of malnutrition, pathophysiological mechanisms, diagnostic tools and therapeutic targets to treat malnutrition. Malnutrition is frequently underdiagnosed and occurs-depending on the screening methods used and patient populations studied-in 5-92% of patients. Decreased energy and protein intake, inflammation, malabsorption, altered nutrient metabolism, hypermetabolism, hormonal disturbances and gut microbiome dysbiosis can contribute to malnutrition. The stepwise diagnostic approach includes a rapid prescreen, the use of a specific screening tool, such as the Royal Free Hospital Nutritional Prioritizing Tool and a nutritional assessment by dieticians. General dietary measures-especially the timing of meals-oral nutritional supplements, micronutrient supplementation and the role of amino acids are discussed. In summary malnutrition in cirrhosis is common and needs more attention by health care professionals involved in the care of patients with cirrhosis. Screening and assessment for malnutrition should be carried out regularly in cirrhotic patients, ideally by a multidisciplinary team. Further research is needed to better clarify pathogenic mechanisms such as the role of the gut-liver-axis and to develop targeted therapeutic strategies.
肝硬化是全球日益严重的公共卫生威胁。营养不良是肝硬化的严重并发症，与预后不良有关。通过本次综述，我们旨在描述营养不良的流行率、病理生理机制、诊断工具和治疗营养不良的治疗靶点。营养不良经常被漏诊，其发生率取决于所使用的筛查方法和研究的患者人群，在 5%-92%的患者中发生。能量和蛋白质摄入减少、炎症、吸收不良、营养物质代谢改变、高代谢、激素紊乱和肠道微生物失调都可能导致营养不良。逐步诊断方法包括快速预筛查、使用特定的筛查工具，如皇家自由医院营养优先工具，以及营养师进行营养评估。一般的饮食措施，特别是进餐时间、口服营养补充剂、微量营养素补充剂以及氨基酸的作用都在讨论范围内。总之，肝硬化患者中营养不良很常见，需要参与肝硬化患者治疗的医护人员给予更多关注。应定期对肝硬化患者进行营养不良筛查和评估，理想情况下由多学科团队进行。需要进一步研究以更好地阐明发病机制，如肠道-肝脏轴的作用，并开发有针对性的治疗策略。
