Nutrients

Editorial

Jump to: Research, Review

3 pages, 193 KiB

Open AccessEditorial

Nutrition in Liver Cirrhosis and Transplantation—Current State and Knowledge Gaps

by Maitreyi Raman, Puneeta Tandon and Manuela Merli

Nutrients 2020, 12(3), 680; https://doi.org/10.3390/nu12030680 - 03 Mar 2020

Cited by 1 | Viewed by 2642

Abstract

Cirrhosis of the liver is a leading cause of morbidity and mortality [...] Full article

(This article belongs to the Special Issue Nutrition in Liver Cirrhosis and Liver Transplantation)

Research

Jump to: Editorial, Review

9 pages, 1087 KiB

Open AccessArticle

Weight Gain and De Novo Metabolic Disorders after Liver Transplantation

by Barbara Lattanzi, Daria D’Ambrosio, Daniele Tavano, Demis Pitoni, Gianluca Mennini, Stefano Ginanni Corradini, Massimo Rossi and Manuela Merli

Nutrients 2019, 11(12), 3015; https://doi.org/10.3390/nu11123015 - 10 Dec 2019

Cited by 10 | Viewed by 2574

Abstract

The development of nutritional and metabolic abnormalities represents an important burden in patients after liver transplantation (LT). Our study aimed at evaluating the incidence, time of onset, and risk factors for nutritional and metabolic abnormalities in patients after LT. The study was a [...] Read more.

The development of nutritional and metabolic abnormalities represents an important burden in patients after liver transplantation (LT). Our study aimed at evaluating the incidence, time of onset, and risk factors for nutritional and metabolic abnormalities in patients after LT. The study was a single-center retrospective study. Consecutive patients undergoing elective LT from 2000 to 2016 were enrolled. The presence of at least two among arterial hypertension (AH), diabetes mellitus (DM), dyslipidemia, and obesity (BMI ≥ 30 Kg/m²) was utilized to define patients with the metabolic disorder (MD). Three hundred and fifteen patients were enrolled; the median age was 56 years (68% males). Non-alcoholic steatohepatitis (NASH) was the origin of liver disease in 10% of patients. During follow-up, 39% of patients developed AH, 18% DM, and 17% dyslipidemia. Metabolic disorders were observed in 32% of patients. The NASH etiology (OR: 6.2; CI 95% 0.5–3; p = 0.003) and a longer follow-up (OR: 1.2; CI 95% 0.004–0.02; p = 0.002) were associated with de novo MD. In conclusion, nutritional and metabolic disorders are a frequent complication after LT, being present in up to one-third of patients. The NASH etiology and a longer distance from LT are associated with de novo MD after LT. Full article

(This article belongs to the Special Issue Nutrition in Liver Cirrhosis and Liver Transplantation)

► Show Figures

Figure 1

14 pages, 636 KiB

Open AccessArticle

Impact of Bacterial Translocation on Sarcopenia in Patients with Decompensated Cirrhosis

by Cynthia Tsien, Lilia Antonova, Jose Such, Irma Garcia-Martinez and Florence Wong

Nutrients 2019, 11(10), 2379; https://doi.org/10.3390/nu11102379 - 05 Oct 2019

Cited by 10 | Viewed by 2851

Abstract

Advanced liver disease is associated with a persistent inflammatory state, derived from abnormal bacterial translocation from the gut, which may contribute to the development of sarcopenia in cirrhosis. We aim to document the association of chronic inflammation and bacterial translocation with the presence [...] Read more.

Advanced liver disease is associated with a persistent inflammatory state, derived from abnormal bacterial translocation from the gut, which may contribute to the development of sarcopenia in cirrhosis. We aim to document the association of chronic inflammation and bacterial translocation with the presence of sarcopenia in cirrhosis. We prospectively followed cirrhotic patients aged 18–70 years with medically refractory ascites at a single tertiary care center in Toronto, Canada. The baseline data included patient demographic variables, the presence of bacterial DNA in serum/ascitic fluid, systemic inflammatory response syndrome (SIRS) status, and nutritional assessment. Thirty-one patients were enrolled, 18 (58.1%) were sarcopenic, 9 (29%) had bacterial DNA in serum and ascites fluid. The mean MELD score was 11.5 ± 4.0 (6–23). Sarcopenic and non-sarcopenic patients did not differ significantly in their baseline MELD scores, caloric intake, resting energy expenditure, the incidence of bacterial translocation, or SIRS. While sarcopenia was not linked to increased hospital admissions or death, it was strongly associated with increased episodes of acute kidney injury (3 vs. 0, p = 0.05). This pilot study did not demonstrate an association between sarcopenia and SIRS or bacterial translocation. These results should be confirmed in future larger studies, encompassing a greater number of chronic inflammation events and quantifying levels of bacterial DNA. Full article

(This article belongs to the Special Issue Nutrition in Liver Cirrhosis and Liver Transplantation)

► Show Figures

Figure 1

14 pages, 3011 KiB

Open AccessArticle

A Nutraceutical Rich in Docosahexaenoic Acid Improves Portal Hypertension in a Preclinical Model of Advanced Chronic Liver Disease

by Zoe Boyer-Diaz, Joan Carles Domingo, Estefanía De Gregorio, Nicolò Manicardi, Peio Aristu-Zabalza, Begoña Cordobilla, Laia Abad-Jordà, Martí Ortega-Ribera, Anabel Fernández-Iglesias, Montserrat Marí, Jaime Bosch and Jordi Gracia-Sancho

Nutrients 2019, 11(10), 2358; https://doi.org/10.3390/nu11102358 - 03 Oct 2019

Cited by 15 | Viewed by 4014

Abstract

Inflammation and oxidative stress play a key role in the pathophysiology of advanced chronic liver disease (ACLD) and portal hypertension (PH). Considering the current lack of effective treatments, we evaluated an anti-inflammatory and antioxidant nutraceutical rich in docosahexaenoic acid (DHA) as a possible [...] Read more.

Inflammation and oxidative stress play a key role in the pathophysiology of advanced chronic liver disease (ACLD) and portal hypertension (PH). Considering the current lack of effective treatments, we evaluated an anti-inflammatory and antioxidant nutraceutical rich in docosahexaenoic acid (DHA) as a possible therapy for ACLD. We investigated the effects of two-week DHA supplementation (500 mg/kg) on hepatic fatty acids, PH, oxidative stress, inflammation, and hepatic stellate cell (HSC) phenotype in rats with ACLD. Additionally, the effects of DHA were evaluated in murine macrophages and human HSC. In contrast to vehicle-treated animals, cirrhotic rats receiving DHA reestablished a healthy hepatic fatty acid profile, which was associated with an improvement in PH. The mechanisms underlying this hemodynamic improvement included a reduction in oxidative stress and inflammation, as well as a marked HSC deactivation, confirmed in human HSC. Experiments with cultured macrophages showed that treatment with DHA protects against pro-inflammatory insults. The present preclinical study demonstrates that a nutraceutical rich in DHA significantly improves PH in chronic liver disease mainly by suppressing inflammation and oxidative stress-driven HSC activation, encouraging its evaluation as a new treatment for PH and cirrhosis. Full article

(This article belongs to the Special Issue Nutrition in Liver Cirrhosis and Liver Transplantation)

► Show Figures

Figure 1

11 pages, 914 KiB

Open AccessArticle

The Effect of 12 Weeks of β-Hydroxy-β-Methyl-Butyrate Supplementation after Liver Transplantation: A Pilot Randomized Controlled Study

by Barbara Lattanzi, Michela Giusto, Carlina Albanese, Gianluca Mennini, Daria D’Ambrosio, Alessio Farcomeni, Stefano Ginanni Corradini, Massimo Rossi and Manuela Merli

Nutrients 2019, 11(9), 2259; https://doi.org/10.3390/nu11092259 - 19 Sep 2019

Cited by 23 | Viewed by 5816

Abstract

Sarcopenia is a frequent complication in liver transplant (LT) recipients. β-hydroxy-β-methyl-butyrate (HMB) has the potential to increase muscle-performance and tropism. Our study aims at evaluating the effect on muscle mass and functioning, and the safety of 12 weeks of HMB supplementation in patients [...] Read more.

Sarcopenia is a frequent complication in liver transplant (LT) recipients. β-hydroxy-β-methyl-butyrate (HMB) has the potential to increase muscle-performance and tropism. Our study aims at evaluating the effect on muscle mass and functioning, and the safety of 12 weeks of HMB supplementation in patients after LT. This is a pilot, randomized study. Male patients undergoing LT were randomly assigned to the HMB or control group. A diet interview, anthropometry and body composition by dual energy X-ray absorptiometry (DEXA) were performed at enrollment (T0), after 12 weeks (T1) and after 12 months (T12). Twenty-two liver transplant male patients were enrolled in the study: 12 in the HMB group and 10 as the control group. At enrollment, demographic, clinical and nutritional data were similar. According to the appendicular skeletal muscle index, sarcopenia was present in 50% of patients. The appendix skeletal muscle mass index (ASMI) showed a significant increase at T1 and T12 in HMB patients, but not in controls. The mid-arm muscle-circumference and hand grip strength also increased at T1 and T12 versus T0 only in the HMB group. No side effects were reported in either group. The study showed a positive effect of HMB in the recovery of muscle mass and strength after LT. HMB supplement in patients after LT was safe and well tolerated. Full article

(This article belongs to the Special Issue Nutrition in Liver Cirrhosis and Liver Transplantation)

► Show Figures

Graphical abstract

11 pages, 728 KiB

Open AccessArticle

Nutrition Risk Assessment Using the Modified NUTRIC Score in Cirrhotic Patients with Acute Gastroesophageal Variceal Bleeding: Prevalence of High Nutrition Risk and its Independent Prognostic Value

by Ming-Hung Tsai, Hui-Chun Huang, Yun-Shing Peng, Yung-Chang Chen, Ya-Chung Tian, Chih-Wei Yang, Jau-Min Lien, Ji-Tseng Fang, Ming-Chih Hou, Chien-Heng Shen, Chung-Chi Huang, Cheng-Shyong Wu and Fa-Yauh Lee

Nutrients 2019, 11(9), 2152; https://doi.org/10.3390/nu11092152 - 09 Sep 2019

Cited by 15 | Viewed by 3536

Abstract

Malnutrition is associated with adverse outcomes in patients with liver cirrhosis. Relevant data about nutrition risk in critically ill cirrhotic patients are lacking. The modified Nutrition Risk in Critically Ill (mNUTRIC) score is a novel nutrition risk assessment tool specific for intensive care [...] Read more.

Malnutrition is associated with adverse outcomes in patients with liver cirrhosis. Relevant data about nutrition risk in critically ill cirrhotic patients are lacking. The modified Nutrition Risk in Critically Ill (mNUTRIC) score is a novel nutrition risk assessment tool specific for intensive care unit (ICU) patients. This retrospective study was conducted to evaluate the prevalence and prognostic significance of nutrition risk in cirrhotic patients with acute gastroesophageal variceal bleeding (GEVB) using mNUTRIC scores computed on admission to the intensive care unit. The major outcome was 6-week mortality. One-hundred-and-thirty-one admissions in 120 patients were analyzed. Thirty-eight percent of cirrhotic patients with acute GEVB were categorized as being at high nutrition risk (a mNUTRIC score of ≥5). There was a significantly progressive increase in mortality associated with the mNUTRIC score (χ² for trend, p < 0.001). By using the area under a receiver operating characteristic (ROC) curve, the mNUTRIC demonstrated good discriminative power to predict 6-week mortality (AUROC 0.859). In multivariate analysis, the mNUTRIC score was an independent factor associated with 6-week mortality. In conclusion, the mNUTRIC score can serve as a tool to assess nutrition risk in cirrhotic patients with acute GEVB. Full article

(This article belongs to the Special Issue Nutrition in Liver Cirrhosis and Liver Transplantation)

► Show Figures

Figure 1

8 pages, 675 KiB

Open AccessCommunication

Late-Evening Snack with Branched-Chain Amino Acid-Enriched Nutrients Does Not Always Inhibit Overt Diabetes in Patients with Cirrhosis: A Pilot Study

by Keisuke Nakanishi, Tadashi Namisaki, Tsuyoshi Mashitani, Kosuke Kaji, Kuniaki Ozaki, Soichiro Saikawa, Shinya Sato, Takashi Inoue, Yasuhiko Sawada, Kou Kitagawa, Hiroaki Takaya, Naotaka Shimozato, Hideto Kawaratani, Kei Moriya, Takemi Akahane, Akira Mitoro and Hitoshi Yoshiji

Nutrients 2019, 11(9), 2140; https://doi.org/10.3390/nu11092140 - 07 Sep 2019

Cited by 5 | Viewed by 3254

Abstract

Cirrhosis patients often have abnormal glucose metabolism. We investigated the effects of a late-evening snack (LES) with branched-chain amino acid-enriched nutrients (BCAA-EN) on glucose metabolism in cirrhosis patients. LES with BCAA-EN was administered for 1 week in 13 patients with cirrhosis and hypoalbuminemia. [...] Read more.

Cirrhosis patients often have abnormal glucose metabolism. We investigated the effects of a late-evening snack (LES) with branched-chain amino acid-enriched nutrients (BCAA-EN) on glucose metabolism in cirrhosis patients. LES with BCAA-EN was administered for 1 week in 13 patients with cirrhosis and hypoalbuminemia. Blood glucose (BG) levels were measured every 15 min. The patients were divided into two groups based on BG levels: group 1 (G1, n = 11): nocturnal BG levels <200 mg/dL and group 2 (G2, n = 2): nocturnal BG levels ≥200 mg/dL. G1 had nocturnal BG levels <200 mg/dL, whereas G2 had nocturnal BG levels ≥200 mg/dL. The average BG levels did not significantly change after BCAA-EN administration in G1 (before 91.9 ± 29.0 mg/dL; after 89.0 ± 24.3 mg/dl). However, the average BG levels significantly increased after BCAA-EN administration in G2 (before 153.6 ± 43.3 mg/dL; after 200.9 ± 59.7 mg/dL) (p < 0.01). The glycated albumin level (16.6 ± 0.9% vs. 16.2 ± 2.1%), fasting immunoreactive insulin (F-IRI) level (53.9 ± 34.0 μU/mL vs. 16.5 ± 11.0 μU/mL), and homeostasis model assessment of insulin resistance (HOMA-IR) score (17.85 ± 10.58 vs. 4.02 ± 2.59) were significantly higher in G2 than in G1 (p < 0.05, p < 0.05, and p < 0.01, respectively). The quantitative insulin sensitivity check indices (0.32 ± 0.03 vs. 0.27 ± 0.02) were significantly higher in G1 than in G2 (p < 0.01). One patient in G2 was obese and had type 2 diabetes. The other patient was obese and had a high HOMA-IR score and F-IRI level. A LES with BCAA-EN does not inhibit overt diabetes in most cirrhosis patients. However, close attention should be paid to fluctuations in BG levels in cirrhosis patients who present with obesity and severe insulin resistance. Full article

(This article belongs to the Special Issue Nutrition in Liver Cirrhosis and Liver Transplantation)

► Show Figures

Graphical abstract

15 pages, 1810 KiB

Open AccessArticle

The Relationship of Obesity, Nutritional Status and Muscle Wasting in Patients Assessed for Liver Transplantation

by Helen Vidot, Katharine Kline, Robert Cheng, Liam Finegan, Amelia Lin, Elise Kempler, Simone I. Strasser, David Geoffrey Bowen, Geoffrey William McCaughan, Sharon Carey, Margaret Allman-Farinelli and Nicholas Adam Shackel

Nutrients 2019, 11(9), 2097; https://doi.org/10.3390/nu11092097 - 04 Sep 2019

Cited by 24 | Viewed by 4662

Abstract

Introduction: Obesity co-exists with malnutrition and muscle atrophy in patients with cirrhosis. Muscle wasting is a feature of sarcopenia, a known determinant of patient outcomes. This is the first description of a relationship between obesity, subjective global assessment (SGA) of nutritional status and [...] Read more.

Introduction: Obesity co-exists with malnutrition and muscle atrophy in patients with cirrhosis. Muscle wasting is a feature of sarcopenia, a known determinant of patient outcomes. This is the first description of a relationship between obesity, subjective global assessment (SGA) of nutritional status and muscle wasting in patients with cirrhosis. Methods: The relationship between body mass index (BMI with obesity defined as ≥ 30 kg/m²), nutritional status (assessed by liver-specific subjective global assessment—SGA) and muscle wasting (assessed by corrected total cross-sectional psoas muscle area—cTPA) was analysed in patients with cirrhosis considered for liver transplantation between 1 January 2012 and 31 December 2014. Results: There were 205 patients, of whom 70% were males. The mean age was 52 ± 0.7 years and the Model for End-Stage Liver Disease (MELD) score was 16.8 ± 0.5. Overall, 31% of patients were obese and 56% of well-nourished (SGA A) individuals were obese. Muscle wasting was identified in 86% of all patients, irrespective of their nutritional status (A, B, C). All obese males classified as well-nourished (SGA A) were sarcopenic and 62% of obese females classified as SGA A were sarcopenic. Muscle wasting was worse in obese individuals (cTPA 230.9 mm²/m² ± 12.9, p < 0.0001) and more likely to be associated with hepatic encephalopathy (p = 0.03). Univariate and multivariate analysis demonstrated testosterone deficiency was significantly associated with muscle wasting (p = 0.007) but not obesity (p = 0.8). Conclusion: Obesity combined with muscle wasting is common in patients with cirrhosis. Muscle wasting is common in well-nourished (SGA A) obese patients. Consequently, all patients assessed for liver transplantation should undergo additional screening for malnutrition and muscle wasting irrespective of BMI. Full article

(This article belongs to the Special Issue Nutrition in Liver Cirrhosis and Liver Transplantation)

► Show Figures

Figure 1

17 pages, 1261 KiB

Open AccessArticle

Supplementation with Synbiotics and/or Branched Chain Amino Acids in Hepatic Encephalopathy: A Pilot Randomised Placebo-Controlled Clinical Study

by Helen Vidot, Erin Cvejic, Liam J. Finegan, E. Arthur Shores, David G. Bowen, Simone I. Strasser, Geoffrey W. McCaughan, Sharon Carey, Margaret Allman-Farinelli and Nicholas A. Shackel

Nutrients 2019, 11(8), 1810; https://doi.org/10.3390/nu11081810 - 06 Aug 2019

Cited by 31 | Viewed by 5045

Abstract

Introduction: Hepatic encephalopathy (HE) is common in patients with cirrhosis and is characterised by reduced hepatic ammonia clearance. This is accompanied by alterations in gut bacteria that may be ameliorated with synbiotics (pro- and prebiotics). Branched chain amino acids (BCAAs) are thought to [...] Read more.

Introduction: Hepatic encephalopathy (HE) is common in patients with cirrhosis and is characterised by reduced hepatic ammonia clearance. This is accompanied by alterations in gut bacteria that may be ameliorated with synbiotics (pro- and prebiotics). Branched chain amino acids (BCAAs) are thought to have a role in the detoxification of ammonia. We investigated the effects of the administration of synbiotics and/or BCAAs in treating HE. Methods: Participants with overt HE were randomised in a blinded placebo-controlled study to receive synbiotics, BCAAs, or a combination of BCAAs and Synbiotics. Relevant biochemical and nutritional data and depression and anxiety scores (DASS-21) were collected at entry, 4 weeks, and on completion, at 8 weeks. The Trail Making Test (TMT) and Inhibitory Control Test (ICT) were used to assess cognitive function in patients withHE. Results were analysed using linear mixed effects regression analyses. Results: Sixty-one participants were enrolled and 49 who returned for at least 1 follow-up review were included in the intention to treat analysis. The mean age was 55.8 ± 6.1 years and 86% were males. Despite evidence of a placebo effect, there was significant improvement in TMT B and ICT weighted lures in participants who received combined synbiotics/BCAAs treatment compared to placebo at study completion (p ≤ 0.05). Cognitive improvement occurred without a significant change in ammonia levels. Conclusion: To our knowledge, this is the first study reporting that combined synbiotics and BCAAs improve HE, and that may be beneficial in the management of HE. A larger study is needed to confirm these results. Full article

(This article belongs to the Special Issue Nutrition in Liver Cirrhosis and Liver Transplantation)

► Show Figures

Figure 1

13 pages, 1276 KiB

Open AccessArticle

Indirect Calorimetry Performance Using a Handheld Device Compared to the Metabolic Cart in Outpatients with Cirrhosis

by Lauren Schock, Louisa Lam, Puneeta Tandon, Lorian Taylor and Maitreyi Raman

Nutrients 2019, 11(5), 1030; https://doi.org/10.3390/nu11051030 - 08 May 2019

Cited by 5 | Viewed by 3450

Abstract

Addressing malnutrition is important to improve health outcomes in outpatients with cirrhosis, yet assessing energy requirements in this population is challenging. Predictive equations of resting energy expenditure (REE) are thought to be unreliable, and traditional indirect calorimetry is expensive and infrequently available for [...] Read more.

Addressing malnutrition is important to improve health outcomes in outpatients with cirrhosis, yet assessing energy requirements in this population is challenging. Predictive equations of resting energy expenditure (REE) are thought to be unreliable, and traditional indirect calorimetry is expensive and infrequently available for clinical use. The accuracy of REE predictions using a MedGem^® handheld indirect calorimeter, the Harris Benedict Equation (HBE), the Mifflin St. Jeor equation (MSJ), and the gold standard Vmax Encore^® (Vmax) metabolic cart was compared. The REE of cirrhotic pre-liver transplant outpatients was analyzed using each of the four methods. Agreement between methods was calculated using Bland–Altman analysis. Fourteen patients with cirrhosis participated, and were primarily male (71%) and malnourished (subjective global assessment (SGA) B or C 64%). Lin’s concordance coefficient (ρC) for MedGem^® vs. Vmax demonstrated poor levels of precision and accuracy (ρC = 0.80, 95% confidence interval 0.55–0.92) between measures, as did the HBE compared to Vmax (ρC = 0.56, 95% confidence interval 0.19–0.79). Mean REE by MedGem^® was similar to that measured by Vmax (−1.5%); however, only 21% of REE measures by MedGem^® were within ±5% of Vmax measures. Wide variability limits the use of MedGem^® at an individual level; a more accurate and feasible method for determination of REE in patients with cirrhosis and malnutrition is needed. Full article

(This article belongs to the Special Issue Nutrition in Liver Cirrhosis and Liver Transplantation)

► Show Figures

Figure 1

Review

Jump to: Editorial, Research

24 pages, 2707 KiB

Open AccessReview

Assessment of Malnutrition, Sarcopenia and Frailty in Patients with Cirrhosis: Which Tools Should We Use in Clinical Practice?

by Benjamin Buchard, Yves Boirie, Lucie Cassagnes, Géraldine Lamblin, A. Coilly and Armando Abergel

Nutrients 2020, 12(1), 186; https://doi.org/10.3390/nu12010186 - 09 Jan 2020

Cited by 71 | Viewed by 9620

Abstract

Malnutrition is a common comorbidity in patients with cirrhosis. Its prognostic value is indisputable as it greatly affects the evolution of liver diseases. It has a major impact on both morbi-mortality before and after liver transplantation. Being now integrated in the definition of [...] Read more.

Malnutrition is a common comorbidity in patients with cirrhosis. Its prognostic value is indisputable as it greatly affects the evolution of liver diseases. It has a major impact on both morbi-mortality before and after liver transplantation. Being now integrated in the definition of malnutrition and recognized as a new entity in the international classification of diseases, physicians have taken great interest in sarcopenia. Its negative consequences on the fate of patients with cirrhosis are well-demonstrated. The concept of frailty has recently been enlarged to chronic liver diseases as symptoms of impaired global physical functioning. In this article, we will discuss the definitions of malnutrition and emphasize its links with sarcopenia and frailty. We will show the relevance of frailty and sarcopenia in the course of liver diseases. The emerging role of muscle depletion on the cardiorespiratory system will also be highlighted. The importance of body composition will be demonstrated and the main tools reviewed. Finally, we adapted the definition of malnutrition to patients with cirrhosis based on the assessment of sarcopenia together with reduced food intakes. Full article

(This article belongs to the Special Issue Nutrition in Liver Cirrhosis and Liver Transplantation)

► Show Figures

Figure 1

19 pages, 638 KiB

Open AccessReview

Obesity in the Liver Transplant Setting

by Carlos Moctezuma-Velazquez, Ernesto Márquez-Guillén and Aldo Torre

Nutrients 2019, 11(11), 2552; https://doi.org/10.3390/nu11112552 - 23 Oct 2019

Cited by 30 | Viewed by 4887

Abstract

The obesity epidemic has resulted in an increased prevalence of obesity in liver transplant (LT) candidates and in non-alcoholic fatty liver disease (NAFLD) becoming the fastest growing indication for LT. LT teams will be dealing with obesity in the coming years, and it [...] Read more.

The obesity epidemic has resulted in an increased prevalence of obesity in liver transplant (LT) candidates and in non-alcoholic fatty liver disease (NAFLD) becoming the fastest growing indication for LT. LT teams will be dealing with obesity in the coming years, and it is necessary for them to recognize some key aspects surrounding the LT in obese patients. Obesity by itself should not be considered a contraindication for LT, but it should make LT teams pay special attention to cardiovascular risk assessment, in order to properly select candidates for LT. Obese patients may be at increased risk of perioperative respiratory and infectious complications, and it is necessary to establish preventive strategies. Data on patient and graft survival after LT are controversial and scarce, especially for long-term outcomes, but morbid obesity may adversely affect these outcomes, particularly in NAFLD. The backbone of obesity treatment should be diet and exercise, whilst being careful not to precipitate or worsen frailty and sarcopenia. Bariatric surgery is an alternative for treatment of obesity, and the ideal timing regarding LT is still unknown. Sleeve gastrectomy is probably the procedure that has the best evidence in LT because it offers a good balance between safety and efficacy. Full article

(This article belongs to the Special Issue Nutrition in Liver Cirrhosis and Liver Transplantation)

► Show Figures

Figure 1

10 pages, 754 KiB

Open AccessReview

The Analysis of Food Intake in Patients with Cirrhosis Waiting for Liver Transplantation: A Neglected Step in the Nutritional Assessment

by Francesco Palmese, Ilaria Bolondi, Ferdinando Antonino Giannone, Giacomo Zaccherini, Manuel Tufoni, Maurizio Baldassarre and Paolo Caraceni

Nutrients 2019, 11(10), 2462; https://doi.org/10.3390/nu11102462 - 15 Oct 2019

Cited by 14 | Viewed by 3056

Abstract

Patients with cirrhosis waiting for liver transplantation (LT) frequently present a nutritional disorder, which represents an independent predictor of morbidity and mortality before and after transplantation. Thus, a proper assessment of the food intake by using different methods, such as food records, food [...] Read more.

Patients with cirrhosis waiting for liver transplantation (LT) frequently present a nutritional disorder, which represents an independent predictor of morbidity and mortality before and after transplantation. Thus, a proper assessment of the food intake by using different methods, such as food records, food frequency questionnaires, and 24 h recall, should be deemed an important step of the nutritional management of these patients. The available published studies indicate that the daily food intake is inadequate in the majority of waitlisted patients. These findings were confirmed by our experience, showing that the daily intake of total calories, proteins and carbohydrates was inadequate in approximately 85–95% of patients, while that of lipids and simple carbohydrates was inadequate in almost 50% of them. These data highlight the need to implement an effective educational program provided by certified nutritionists or dieticians, who should work in close collaboration with the hepatologist to provide a nutritional intervention tailored to the individual patient requirements. Full article

(This article belongs to the Special Issue Nutrition in Liver Cirrhosis and Liver Transplantation)

► Show Figures

Figure 1

16 pages, 306 KiB

Open AccessReview

Controversies in Diagnosing Sarcopenia in Cirrhosis—Moving from Research to Clinical Practice

by Marie Sinclair

Nutrients 2019, 11(10), 2454; https://doi.org/10.3390/nu11102454 - 14 Oct 2019

Cited by 23 | Viewed by 3240

Abstract

Sarcopenia, defined as loss of muscle mass and function, is increasingly recognized as a common consequence of advanced cirrhosis that is associated with adverse clinical outcomes. Despite the recent proliferation in publications pertaining to sarcopenia in end-stage liver disease, there remains no single [...] Read more.

Sarcopenia, defined as loss of muscle mass and function, is increasingly recognized as a common consequence of advanced cirrhosis that is associated with adverse clinical outcomes. Despite the recent proliferation in publications pertaining to sarcopenia in end-stage liver disease, there remains no single ‘best method’ for its diagnosis. The inability to identify a gold standard is common to other specialties, including geriatrics from which many diagnostic tools are derived. Controversies in diagnosis have implications for the accuracy and reproducibility of cohort studies in the field, largely prohibit the introduction of sarcopenia measurement into routine patient care and impede the development of clinical trials to identify appropriate therapies. Difficulties in diagnosis are partly driven by our ongoing limited understanding of the pathophysiology of sarcopenia in cirrhosis, the mechanisms by which it impacts on patient outcomes, the heterogeneity of patient populations, and the accuracy, availability and cost of assessments of muscle mass and function. This review discusses the currently studied diagnostic methods for sarcopenia in cirrhosis, and outlines why reaching a consensus on sarcopenia diagnosis is important and suggests potential ways to improve diagnostic criteria to allow us to translate sarcopenia research into improvements in clinical care. Full article

(This article belongs to the Special Issue Nutrition in Liver Cirrhosis and Liver Transplantation)

18 pages, 1775 KiB

Open AccessReview

Are Predictive Energy Expenditure Equations Accurate in Cirrhosis?

by Tannaz Eslamparast, Benjamin Vandermeer, Maitreyi Raman, Leah Gramlich, Vanessa Den Heyer, Dawn Belland, Mang Ma and Puneeta Tandon

Nutrients 2019, 11(2), 334; https://doi.org/10.3390/nu11020334 - 04 Feb 2019

Cited by 21 | Viewed by 4732

Abstract

Malnutrition is associated with significant morbidity and mortality in cirrhosis. An accurate nutrition prescription is an essential component of care, often estimated using time-efficient predictive equations. Our aim was to compare resting energy expenditure (REE) estimated using predictive equations (predicted REE, pREE) versus [...] Read more.

Malnutrition is associated with significant morbidity and mortality in cirrhosis. An accurate nutrition prescription is an essential component of care, often estimated using time-efficient predictive equations. Our aim was to compare resting energy expenditure (REE) estimated using predictive equations (predicted REE, pREE) versus REE measured using gold-standard, indirect calorimetry (IC) (measured REE, mREE). We included full-text English language studies in adults with cirrhosis comparing pREE versus mREE. The mean differences across studies were pooled with RevMan 5.3 software. A total of 17 studies (1883 patients) were analyzed. The pooled cohort was comprised of 65% men with a mean age of 53 ± 7 years. Only 45% of predictive equations estimated energy requirements to within 90–110% of mREE using IC. Eighty-three percent of predictive equations underestimated and 28% overestimated energy needs by ±10%. When pooled, the mean difference between the mREE and pREE was lowest for the Harris–Benedict equation, with an underestimation of 54 (95% CI: 30–137) kcal/d. The pooled analysis was associated with significant heterogeneity (I² = 94%). In conclusion, predictive equations calculating REE have limited accuracy in patients with cirrhosis, most commonly underestimating energy requirements and are associated with wide variations in individual comparative data. Full article

(This article belongs to the Special Issue Nutrition in Liver Cirrhosis and Liver Transplantation)

► Show Figures

Figure 1

Journal Menu

Journal Browser

Nutrition in Liver Cirrhosis and Liver Transplantation

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Published Papers (15 papers)

Editorial

Research

Review

Further Information

Guidelines

MDPI Initiatives

Follow MDPI