Nielsen K, Kondrup J, Martinsen L, Stilling B, Wikman B
Medical Department A, Rigshospitalet, Copenhagen, Denmark.
Br J Nutr. 1993 May;69(3):665-79. doi: 10.1079/bjn19930068.
Nutritional assessment and adequacy of spontaneous dietary intake was evaluated in thirty-seven clinically stable hospitalized patients with alcoholic liver cirrhosis. About two-thirds of the patients had ascites or oedema, or both, and, therefore, body weight could not be used for assessment of nutritional status. Lean body mass (LBM; measured by three consecutive 24 h creatinine excretions) was 62 (range 40-95)% of reference values, mid-arm-muscle area (MAMA) was 70 (range 43-115)% and triceps skinfold (TSF) was 45 (range 20-113)% of reference values (all median values). In patients without ascites or oedema, or both, there was a rectilinear correlation between body weight and LBM and between body weight and MAMA (r 0.93 and 0.85 respectively). In patients with ascites or oedema, or both, the correlation between body weight and LBM was poor as could be expected. We suggest that LBM is a useful measure of nutritional status when body weight is unreliable because of ascites or oedema, or both. Energy balance for the group was calculated from energy intake recorded by a 24 h dietary recall and energy expenditure calculated by the factorial method. Median intake was 102 (range 34-176)% of expenditure. N loss was calculated from the average of three 24 h urea excretions. Protein intake was calculated from the 24 h dietary recall. The N balance was positive in the patients as a group (median intake was 120 (range 26-183)% of output). The most malnourished patients tended to have the most positive N balance which was due to a significantly lower N excretion. The protein requirement for N balance was 0.83 (SE 0.05) g/kg per d and only at an intake above 1.20 g/kg per d were all patients in positive N balance. The median intakes of thiamin, folacin, vitamin D, vitamin E, Mg, and Zn were judged to be insufficient. It is concluded that impaired nutritional status is common among patients with liver cirrhosis, even in a stable clinical condition. It is suggested that nutritional status in these patients is evaluated by dietary recalls, in combination with measurement of body weight in patients without ascites or oedema, or both, or in combination with determination of LBM by three 24 h creatinine excretions in patients with ascites or oedema, or both. Criteria for selection of patients that might benefit from nutritional therapy are discussed.
对37例临床病情稳定的酒精性肝硬化住院患者的营养状况及自发饮食摄入量是否充足进行了评估。约三分之二的患者有腹水或水肿，或两者皆有，因此，体重不能用于评估营养状况。瘦体重（LBM；通过连续3天24小时肌酐排泄量测定）为参考值的62%（范围40 - 95%），上臂中部肌肉面积（MAMA）为参考值的70%（范围43 - 115%），肱三头肌皮褶厚度（TSF）为参考值的45%（范围20 - 113%）（均为中位数）。在没有腹水或水肿，或两者皆无的患者中，体重与LBM以及体重与MAMA之间呈直线相关（r分别为0.93和0.85）。在有腹水或水肿，或两者皆有的患者中，体重与LBM之间的相关性较差，这是可以预料的。我们认为，当由于腹水或水肿，或两者皆有导致体重不可靠时，LBM是评估营养状况的有用指标。该组患者的能量平衡通过24小时饮食回顾记录的能量摄入和用因子法计算的能量消耗来计算。摄入量中位数为消耗量的102%（范围34 - 176%）。氮损失通过3次24小时尿素排泄量的平均值来计算。蛋白质摄入量通过24小时饮食回顾来计算。作为一个整体，患者的氮平衡为正值（摄入量中位数为排出量的120%（范围26 - 183%））。营养不良最严重的患者往往氮平衡最正，这是由于氮排泄量显著降低所致。氮平衡所需的蛋白质需求量为0.83（标准误0.05）克/千克/天，只有当摄入量高于1.20克/千克/天时，所有患者的氮平衡才为正值。硫胺素、叶酸、维生素D、维生素E、镁和锌的摄入量中位数被判定为不足。结论是，肝硬化患者即使在临床病情稳定的情况下，营养状况受损也很常见。建议通过饮食回顾来评估这些患者的营养状况，对于没有腹水或水肿，或两者皆无的患者，结合体重测量；对于有腹水或水肿，或两者皆有的患者，结合通过连续3天24小时肌酐排泄量测定LBM。文中还讨论了可能从营养治疗中获益的患者的选择标准。
