Department of Dietetics, Leiden University Medical Center, Leiden, the Netherlands.
Department of Dietetics, Leiden University Medical Center, Leiden, the Netherlands.
Clin Nutr ESPEN. 2021 Apr;42:272-279. doi: 10.1016/j.clnesp.2021.01.022. Epub 2021 Feb 10.
Malnutrition is highly prevalent in patients with end-stage liver disease (ESLD) and associated with impaired clinical outcome. Previous studies focused on one component of body composition and not in combination with nutritional intake, while both are components of the nutritional status. We aimed to evaluate the most important risk factors regarding body composition (muscle mass, muscle quality and fat mass) and nutritional intake (energy and protein intake) for waiting list mortality in patients with ESLD awaiting liver transplantation (LTx).
Consecutive patients with ESLD listed for LTx between 2007 and 2014 were investigated. Muscle mass quantity (Skeletal Muscle Mass Index, SMI), and muscle quality (Muscle Attenuation, MA), and various body fat compartments were measured on computed tomography using SliceOmatic. Nutritional intake (e.g. energy and protein intake) was assessed. Multivariable stepwise forward Cox regression analysis was used for statistical analysis.
261 Patients (mean age 54 years, 74.7% male) were included. Low SMI and MA were found to be statistically significant predictors of an increased risk for waiting list mortality in patients with ESLD, with a HR of 2.580 (95%CI 1.055-6.308) and HR of 9.124 (95%CI 2.871-28.970), respectively. No association between percentage adipose tissue, and protein and energy intake with waiting list mortality was found in this study.
Both low muscle quantity and quality, and not nutritional intake, were independent risk factors for mortality in patients with ESLD.
终末期肝病（ESLD）患者营养不良的发生率很高，与临床预后不良有关。以前的研究集中在身体成分的一个组成部分上，而不是与营养摄入相结合，而这两者都是营养状况的组成部分。我们旨在评估与等待肝移植（LTx）的 ESLD 患者等待名单死亡率相关的最重要的身体成分（肌肉量、肌肉质量和脂肪量）和营养摄入（能量和蛋白质摄入）的风险因素。
研究了 2007 年至 2014 年间接受 LTx 的 ESLD 连续患者。使用 SliceOmatic 在计算机断层扫描上测量肌肉质量量（骨骼肌指数，SMI）和肌肉质量（肌肉衰减，MA），以及各种体脂区室。评估营养摄入（例如能量和蛋白质摄入）。使用多变量逐步向前 Cox 回归分析进行统计分析。
261 例患者（平均年龄 54 岁，74.7%为男性）入选。低 SMI 和 MA 被发现是 ESLD 患者等待名单死亡率增加的统计学显著预测因素，风险比分别为 2.580（95%CI 1.055-6.308）和 9.124（95%CI 2.871-28.970）。在这项研究中，没有发现体脂肪百分比、蛋白质和能量摄入与等待名单死亡率之间存在关联。
低肌肉量和质量，而不是营养摄入，是 ESLD 患者死亡的独立危险因素。
