1
|
Ferreira S, Marroni CA, Stein JT, Rayn R, Henz AC, Schmidt NP, Carteri RB, Fernandes SA. Assessment of resting energy expenditure in patients with cirrhosis. World J Hepatol 2022; 14:802-811. [PMID: 35646265 PMCID: PMC9099101 DOI: 10.4254/wjh.v14.i4.802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/13/2022] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Malnutrition affects 20% to 50% of patients with cirrhosis. It may be associated with serious complications and has a direct impact on prognosis. Resting energy expenditure (REE) is an important parameter to guide the optimization of therapy and recovery of nutritional status in patients with cirrhosis. However, the REE of patients with cirrhosis is still unclear, casting doubt upon the optimal nutritional management approach.
AIM To identify the best method that predicts the REE of cirrhotic patients, using indirect calorimetry (IC) as the gold standard.
METHODS An observational study was performed on 90 patients with cirrhosis. REE was assessed by IC, bioelectrical impedance analysis (BIA), and predictive formulas, which were compared using Bland-Altman plots and the Student’s t-test.
RESULTS REE values measured by IC (1607.72 ± 257.4 kcal) differed significantly from those determined by all other methods (BIA: 1790.48 ± 352.1 kcal; Harris & Benedict equation: 2373.54 ± 254.9 kcal; IOM equation: 1648.95 ± 185.6 kcal; Cunningham equation: 1764.29 ± 246.2 kcal), except the Food and Agriculture Organization of the United Nations, World Health Organization, and United Nations University (FAO/WHO/UNU) (1616.07 ± 214.6 kcal) and McArdle (1611.30 ± 241.8 kcal) equations. We found no significant association when comparing IC and 24-h dietary recall among different Child-Pugh classes of cirrhosis.
CONCLUSION The IOM and FAO/WHO/UNU equations have the best agreement with the CI. These results indicate a possibility of different tools for the clinical practice on cirrhotic patients.
Collapse
Affiliation(s)
- Shaiane Ferreira
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Cláudio Augusto Marroni
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Jessica Taina Stein
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Roberta Rayn
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Ana Cristhina Henz
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Natália P Schmidt
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| | - Randhall B Carteri
- Department of Nutrition, Centro Universitário Metodista - IPA, Porto Alegre 90420-060, Brazil
- Department of Health and Behavior, Catholic University of Pelotas, Pelotas 96015-560, Brazil
| | - Sabrina Alves Fernandes
- Postgraduate Program in Hepatology, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre 90050-170, Brazil
| |
Collapse
|
2
|
Henz AC, Marroni CA, Silva DMD, Teixeira JM, Silveira TT, Ferreira S, Silveira AT, Schmidt NP, Stein JT, Rayn RG, Fernandes SA. Resting energy expenditure in cirrhotic patients with and without hepatocellular carcinoma. World J Gastrointest Pharmacol Ther 2021; 12:1-12. [PMID: 33564492 PMCID: PMC7844573 DOI: 10.4292/wjgpt.v12.i1.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/26/2020] [Accepted: 11/12/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The diagnosis of malnutrition in patients with independent hepatocellular carcinoma (HCC) varies from 20% to 50%, is related to important complications and has a direct impact on the prognosis. Determination of the resting energy expenditure (REE) has become an important parameter in this population, as it allows therapeutic adjustments to recover their nutritional status. The REE in cirrhosis, with and without HCC, is not clearly defined, and requires the identification and definition of the best nutritional approach. AIM To evaluate the REE of patients with cirrhosis, with and without HCC. METHODS This is a prospective observational study evaluating the REE of 118 patients, 33 with cirrhosis and hepatocellular carcinoma and a control group of 85 patients with cirrhosis without HCC, using indirect calorimetry (IC), bioimpedance, and predictive formulas. RESULTS The REE determined by IC in cirrhotic patients with HCC was 1643 ± 364 and in those without HCC was 1526 ± 277 (P = 0.064). The REE value as assessed by bioimpedance was 1529 ± 501 for those with HCC and 1660 ± 385 for those without HCC (P = 0.136). When comparing the values of REE determined by IC and predictive formulas in cirrhotics with HCC, it was observed that only the formulas of the Food and Agriculture Organization (FAO)/World Health Organization (WHO) (1985) and Cunningham (1980) presented values similar to those determined by IC. When comparing the REE values determined by IC and predictive formulas in cirrhotics without HCC, it was observed that the formulas of Schofield (1985), FAO/WHO (1985), WHO (2000), Institute of Medicine (IOM) (2005) and Katch and McArdie (1996) presented values similar to those determined by IC. CONCLUSION The FAO/WHO formula (1985) could be used for cirrhotic patients with or without HCC; as it is the one with the values closest to those obtained by IC in these cirrhotic patients.
Collapse
Affiliation(s)
- Ana Cristhina Henz
- Department of Nutrition, Centro Universitário Metodista (IPA), Porto Alegre 90420-060, RS, Brazil
| | - Claudio Augusto Marroni
- Department of Gastroenterology and Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 91760470, RS, Brazil
| | - Daniella Miranda da Silva
- Postgraduate Program in Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
| | - Joise Munari Teixeira
- Postgraduate Program in Medicine, Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
| | - Thiago Thomé Silveira
- Hepatology Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
| | - Shaiane Ferreira
- Hepatology Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
| | - Andresa Thomé Silveira
- Hepatology Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
| | - Natalia Perin Schmidt
- Hepatology Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
| | - Jessica Taina Stein
- Hepatology Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
| | - Roberta Goulart Rayn
- Hepatology Graduate Program, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050170, RS, Brazil
| | - Sabrina Alves Fernandes
- Department of Nutrition, Centro Universitário Metodista (IPA), Porto Alegre 90420-060, RS, Brazil
| |
Collapse
|
3
|
Boulhosa RSSB, Lourenço RP, Côrtes DM, Oliveira LPM, Lyra AC, de Jesus RP. Comparison between criteria for diagnosing malnutrition in patients with advanced chronic liver disease: GLIM group proposal versus different nutritional screening tools. J Hum Nutr Diet 2020; 33:862-868. [PMID: 32378264 DOI: 10.1111/jhn.12759] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Different nutritional screening instruments can be used to identify the risk of malnutrition in advanced chronic liver disease patients. The present study aimed to evaluate and compare two nutrition screening tools with the Global Leadership Initiative on Malnutrition (GLIM) diagnostic criteria for malnutrition in patients with advanced chronic liver disease. METHODS Two nutritional screening tools, Nutritional Risk Screening 2002 (NRS-2002) and Royal Free Hospital Nutritional Prioritizing Tool (RFH-NPT), were assessed for 166 patients with liver cirrhosis. We compared medium/high nutritional risk screening with the diagnosis of malnutrition, using the GLIM criteria as the reference standard. RESULTS According to the GLIM criteria, 57.3% of the patients were malnourished. NRS and RFH-NPT identified, respectively, 36.1% and 52.4% of patients with nutritional risk. RFH-NPT presented better agreement with the diagnosis according to GLIM criteria (k = 0.64; 95% confidence interval = 0.52-0.75), higher sensitivity (80%), higher negative predictive value (79%) and larger area under the curve (82.3%) compared to the NRS. CONCLUSIONS RFH-NPT, when compared with the GLIM method, has substantial agreement in identifying nutritional risk, good sensitivity and good value for diagnosing malnutrition in patients with advanced chronic liver disease.
Collapse
Affiliation(s)
- R S S B Boulhosa
- Food, Nutrition and Health Post-Graduation Program, Federal University of Bahia, Salvador, Brazil
| | | | - D M Côrtes
- Food, Nutrition and Health Post-Graduation Program, Federal University of Bahia, Salvador, Brazil
| | - L P M Oliveira
- Science Nutrition Department, Federal University of Bahia, Salvador, Brazil
| | - A C Lyra
- Department of Gastroenterology, Federal University of Bahia, Salvador, Brazil
| | - R P de Jesus
- Science Nutrition Department, Federal University of Bahia, Salvador, Brazil
| |
Collapse
|
4
|
Phase angle as a marker for sarcopenia in cirrhosis. Clin Nutr ESPEN 2019; 32:56-60. [DOI: 10.1016/j.clnesp.2019.05.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 05/07/2019] [Indexed: 01/04/2023]
|
5
|
Marroni CA, Fleck Jr ADM, Fernandes SA, Galant LH, Mucenic M, de Mattos Meine MH, Mariante-Neto G, Brandão ABDM. Liver transplantation and alcoholic liver disease: History, controversies, and considerations. World J Gastroenterol 2018; 24:2785-2805. [PMID: 30018475 PMCID: PMC6048431 DOI: 10.3748/wjg.v24.i26.2785] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/23/2018] [Accepted: 06/16/2018] [Indexed: 02/06/2023] Open
Abstract
Alcohol consumption accounts for 3.8% of annual global mortality worldwide, and the majority of these deaths are due to alcoholic liver disease (ALD), mainly alcoholic cirrhosis. ALD is one of the most common indications for liver transplantation (LT). However, it remains a complicated topic on both medical and ethical grounds, as it is seen by many as a “self-inflicted disease”. One of the strongest ethical arguments against LT for ALD is the probability of relapse. However, ALD remains a common indication for LT worldwide. For a patient to be placed on an LT waiting list, 6 mo of abstinence must have been achieved for most LT centers. However, this “6-mo rule” is an arbitrary threshold and has never been shown to affect survival, sobriety, or other outcomes. Recent studies have shown similar survival rates among individuals who undergo LT for ALD and those who undergo LT for other chronic causes of end-stage liver disease. There are specific factors that should be addressed when evaluating LT patients with ALD because these patients commonly have a high prevalence of multisystem alcohol-related changes. Risk factors for relapse include the presence of anxiety or depressive disorders, short pre-LT duration of sobriety, and lack of social support. Identification of risk factors and strengthening of the social support system may decrease relapse among these patients. Family counseling for LT candidates is highly encouraged to prevent alcohol consumption relapse. Relapse has been associated with unique histopathological changes, graft damage, graft loss, and even decreased survival in some studies. Research has demonstrated the importance of a multidisciplinary evaluation of LT candidates. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including 12-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Nutritional therapy helps to reverse muscle wasting, weight loss, vitamin deficiencies, and trace element deficiencies associated with ALD. For muscular recovery, supervised physical activity has been shown to lead to a gain in muscle mass and improvement of functional activity. Early LT for acute alcoholic hepatitis has been the subject of recent clinical studies, with encouraging results in highly selected patients. The survival rates after LT for ALD are comparable to those of patients who underwent LT for other indications. Patients that undergo LT for ALD and survive over 5 years have a higher risk of cardiorespiratory disease, cerebrovascular events, and de novo malignancy.
Collapse
Affiliation(s)
- Claudio Augusto Marroni
- Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90430-080, RS, Brazil
- Liver Transplant Adult Group, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90035-072, RS, Brazil
| | - Alfeu de Medeiros Fleck Jr
- Liver Transplant Adult Group, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90035-072, RS, Brazil
| | - Sabrina Alves Fernandes
- Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90430-080, RS, Brazil
- Liver Transplant Adult Group, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90035-072, RS, Brazil
- Nutrition at the Centro Universitário Metodista (IPA), Porto Alegre 90420-060, RS, Brazil
| | - Lucas Homercher Galant
- Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90430-080, RS, Brazil
- Liver Transplant Adult Group, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90035-072, RS, Brazil
| | - Marcos Mucenic
- Liver Transplant Adult Group, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90035-072, RS, Brazil
| | - Mario Henrique de Mattos Meine
- Liver Transplant Adult Group, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90035-072, RS, Brazil
| | - Guilherme Mariante-Neto
- Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90430-080, RS, Brazil
- Liver Transplant Adult Group, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90035-072, RS, Brazil
| | - Ajacio Bandeira de Mello Brandão
- Graduate Program in Medicine: Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90430-080, RS, Brazil
- Liver Transplant Adult Group, Irmandade da Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90035-072, RS, Brazil
| |
Collapse
|
6
|
Nomogram and Validity of a Model for Predicting Malnutrition in Patients on Liver Transplant Lists. Dig Dis Sci 2018; 63:1952-1961. [PMID: 29691779 DOI: 10.1007/s10620-018-5079-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 04/16/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Malnutrition is associated with increased morbimortality in liver transplant patients, and it is important to identify factors related to nutritional status in these patients. AIMS Determine variables associated with malnutrition and create a nomogram in liver transplant candidates. METHODS Cross-sectional study (n = 110). VARIABLES demographic variables, imbalances due to the disease, transplant aetiology and analytical parameters. Physical examination was performed and degree of hepatic dysfunction calculated. Nutritional status was assessed: Controlling Nutritional Status, Spanish Society of Parenteral and Enteral Nutrition criteria, Nutritional Risk Index, Prognostic Nutritional Index or Onodera Index and The Subjective Global Assessment. Logistic regression analysis was performed. A predictive nomogram (discrimination and calibration analysis) was generated. RESULTS Malnourishment was defined according to at least 4 or more of the methods studied. Patients with ascites, encephalopathy and portal hypertension presented malnourishment more frequently. Malnutrition was associated with greater liver dysfunction and lower grip strength. Variables independently associated with malnourishment were encephalopathy and lower albumin values. A nomogram was created to predict malnourishment, with good discriminatory power and calibration. CONCLUSIONS A score was developed for evaluating malnutrition risk. This would provide a tool that makes it possible to quickly and easily identify the risk of malnutrition in liver transplant candidates.
Collapse
|
7
|
Subjective Global Assessment and Handgrip Strength as Predictive Factors in Patients with Liver Cirrhosis. Gastroenterol Res Pract 2017; 2017:8348390. [PMID: 28804497 PMCID: PMC5540494 DOI: 10.1155/2017/8348390] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/11/2017] [Indexed: 12/25/2022] Open
Abstract
Background and Aims Malnutrition is common in patients with chronic liver disease. We aimed to evaluate malnutrition assessment tools in predicting severity and survival of patients with liver cirrhosis. Material and Methods We examined patients with liver cirrhosis. Nutritional evaluation was performed on admission, using subjective global assessment (SGA), handgrip strength (HGS), and anthropometry. Patients were followed up for 6 months. Results We included 100 patients, 72 men, with mean age of 59.2 years. According to disease severity, patients were 23% Child-Pugh A, 46% Child-Pugh B, and 31% Child-Pugh C. SGA and HGS significantly correlated with Child-Pugh, MELD, and MELD-Na scores on admission. At 6 months follow-up, 80.4% (78 of 97) of patients survived, while 3 patients were lost from observation. Survival was predicted by SGA (1 death in 32 patients SGA A, 8 deaths in 46 patients SGA B, and 9 deaths in 19 patients SGA C, p = 0.001) and HGS (25.1 ± 8.5 in deceased versus 30.6 ± 10.9 in survivors, p = 0.046). The mean BMI and MAMC values did not significantly differ between patients who survived or were deceased at 6 months. Conclusion HGS and SGA may predict severity and short-term survival in cirrhotic patients.
Collapse
|
8
|
Hand grip strength: A reliable, reproducible, cost-effective tool to assess the nutritional status and outcomes of cirrhotics awaiting liver transplant. Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
9
|
Belarmino G, Gonzalez MC, Sala P, Torrinhas RS, Andraus W, D’Albuquerque LAC, Pereira RMR, Caparbo VF, Ferrioli E, Pfrimer K, Damiani L, Heymsfield SB, Waitzberg DL. Diagnosing Sarcopenia in Male Patients With Cirrhosis by Dual-Energy X-Ray Absorptiometry Estimates of Appendicular Skeletal Muscle Mass. JPEN J Parenter Enteral Nutr 2017; 42:24-36. [DOI: 10.1177/0148607117701400] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/21/2017] [Indexed: 12/17/2022]
Affiliation(s)
- Giliane Belarmino
- Department of Gastroenterology (LIM 35), Surgical Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Maria Cristina Gonzalez
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, Rio Grande do Sul, Brazil
- Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA
| | - Priscila Sala
- Department of Gastroenterology (LIM 35), Surgical Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Raquel Susana Torrinhas
- Department of Gastroenterology (LIM 35), Surgical Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Wellington Andraus
- Department of Gastroenterology (LIM 35), Surgical Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Rosa Maria R. Pereira
- Laboratory of Bone Metabolism, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Valéria F. Caparbo
- Laboratory of Bone Metabolism, Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Eduardo Ferrioli
- Department of Medical Clinic, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo, Brazil
| | - Karina Pfrimer
- Department of Medical Clinic, Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo, Brazil
| | - Lucas Damiani
- Research Institute, Hospital do Coração de São Paulo, São Paulo, Brazil
| | | | - Dan L. Waitzberg
- Department of Gastroenterology (LIM 35), Surgical Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| |
Collapse
|
10
|
Bruch JP, Álvares-DA-Silva MR, Alves BC, Dall'alba V. REDUCED HAND GRIP STRENGTH IN OVERWEIGHT AND OBESE CHRONIC HEPATITIS C PATIENTS. ARQUIVOS DE GASTROENTEROLOGIA 2017; 53:31-5. [PMID: 27281502 DOI: 10.1590/s0004-28032016000100007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 12/02/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatitis C is a liver disease that causes significant changes in metabolism, and also has an impact on nutritional status. OBJECTIVE To evaluate the nutritional status and cardiovascular risk in patients with chronic hepatitis C. METHODS This cross-sectional study investigated 58 patients with chronic hepatitis C, non-cirrhotic and were not under active pharmacological treatment. Patients with significant alcohol consumption (greater than 10 g ethanol/day) were excluded. Patients underwent nutritional assessment through anthropometric measurements and functional assessment using hand grip strength by dynamometry. The physical activity was assessed using the International Physical Activity Questionnaire. Patients also underwent clinical and laboratory evaluation. Cardiovascular risk was calculated by the Framingham score. RESULTS The mean age of patients was 51.6±9.7 years, 55.2% were female, and 79.3% had genotype 1. The most prevalent degree of fibrosis was F1 (37.9%) followed by F2 (27.6%) and F3 (1.7%). The prevalence of overweight/obesity considering the body mass index was 70.7%. However, 57.7% of men and 68.8% of women were considered malnourished according to hand grip strength. These patients also had waist circumference (93.5±10.7 cm) and neck circumference (37.0±3.6 cm) high. Almost 60% of patients were considered sedentary or irregularly active. In relation to cardiovascular risk, 50% of patients had high risk of suffering a cardiovascular event within 10 years. CONCLUSION Although most patients with hepatitis C presented overweight, associated with high cardiovascular risk, they also have reduced functional capacity, indicative of protein-caloric commitment. Therefore, body mass index can not be considered the only method of assessment for nutritional diagnosis of patients with liver disease. Adopting methods such as hand grip strength can be important for a better understanding of nutritional status of these patients.
Collapse
Affiliation(s)
- Juliana Paula Bruch
- Programa de pós-graduação: Ciências em Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil;, Universidade Federal do Rio Grande do Sul, Programa de pós-graduação: Ciências em Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre RS , Brazil.,Centro de Estudos em Alimentação e Nutrição (CESAN), Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brasil, Universidade Federal do Rio Grande do Sul, Centro de Estudos em Alimentação e Nutrição, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre RS , Brazil
| | - Mário Reis Álvares-DA-Silva
- Programa de pós-graduação: Ciências em Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil;, Universidade Federal do Rio Grande do Sul, Programa de pós-graduação: Ciências em Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre RS , Brazil.,Departamento de Medicina Interna, Faculdade de Medicina, UFRGS, Porto Alegre, RS, Brasil, Universidade Federal do Rio Grande do Sul, Departamento de Medicina Interna, Faculdade de Medicina, UFRGS, Porto Alegre RS , Brazil.,Divisão de Gastroenterologia, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brasil;, Universidade Federal do Rio Grande do Sul, Divisão de Gastroenterologia, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre RS , Brazil
| | - Bruna Cherubini Alves
- Programa de pós-graduação: Ciências em Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil;, Universidade Federal do Rio Grande do Sul, Programa de pós-graduação: Ciências em Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre RS , Brazil.,Centro de Estudos em Alimentação e Nutrição (CESAN), Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brasil, Universidade Federal do Rio Grande do Sul, Centro de Estudos em Alimentação e Nutrição, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre RS , Brazil
| | - Valesca Dall'alba
- Programa de pós-graduação: Ciências em Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brasil;, Universidade Federal do Rio Grande do Sul, Programa de pós-graduação: Ciências em Gastroenterologia e Hepatologia, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre RS , Brazil.,Centro de Estudos em Alimentação e Nutrição (CESAN), Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brasil, Universidade Federal do Rio Grande do Sul, Centro de Estudos em Alimentação e Nutrição, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre RS , Brazil.,Departamento de Nutrição, Faculdade de Medicina, UFRGS, Porto Alegre, RS, Brasil, Universidade Federal do Rio Grande do Sul, Departamento de Nutrição, Faculdade de Medicina, UFRGS, Porto Alegre RS , Brazil.,Divisão de Nutrição, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre, RS, Brasil, Universidade Federal do Rio Grande do Sul, Divisão de Nutrição, Hospital de Clínicas de Porto Alegre, UFRGS, Porto Alegre RS , Brazil
| |
Collapse
|
11
|
Phase Angle Bioelectrical Impedance Analysis (BIA) as a Biomarker Tool for Liver Disease. BIOMARKERS IN DISEASE: METHODS, DISCOVERIES AND APPLICATIONS 2017. [DOI: 10.1007/978-94-007-7675-3_43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
12
|
Pinto AS, Chedid MF, Guerra LT, Álvares-DA-Silva MR, Araújo AD, Guimarães LS, Leipnitz I, Chedid AD, Kruel CRP, Grezzana-Filho TJM, Kruel CDP. ESTIMATING BASAL ENERGY EXPENDITURE IN LIVER TRANSPLANT RECIPIENTS: THE VALUE OF THE HARRIS-BENEDICT EQUATION. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2016; 29:185-188. [PMID: 27759783 PMCID: PMC5074671 DOI: 10.1590/0102-6720201600030013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/14/2016] [Indexed: 12/18/2022]
Abstract
Background: Reliable measurement of basal energy expenditure (BEE) in liver transplant (LT) recipients is necessary for adapting energy requirements, improving nutritional status and preventing weight gain. Indirect calorimetry (IC) is the gold standard for measuring BEE. However, BEE may be estimated through alternative methods, including electrical bioimpedance (BI), Harris-Benedict Equation (HBE), and Mifflin-St. Jeor Equation (MSJ) that carry easier applicability and lower cost. Aim: To determine which of the three alternative methods for BEE estimation (HBE, BI and MSJ) would provide most reliable BEE estimation in LT recipients. Methods: Prospective cross-sectional study including dyslipidemic LT recipients in follow-up at a 735-bed tertiary referral university hospital. Comparisons of BEE measured through IC to BEE estimated through each of the three alternative methods (HBE, BI and MSJ) were performed using Bland-Altman method and Wilcoxon Rank Sum test. Results: Forty-five patients were included, aged 58±10 years. BEE measured using IC was 1664±319 kcal for males, and 1409±221 kcal for females. Average difference between BEE measured by IC (1534±300 kcal) and BI (1584±377 kcal) was +50 kcal (p=0.0384). Average difference between the BEE measured using IC (1534±300 kcal) and MSJ (1479.6±375 kcal) was -55 kcal (p=0.16). Average difference between BEE values measured by IC (1534±300 kcal) and HBE (1521±283 kcal) was -13 kcal (p=0.326). Difference between BEE estimated through IC and HBE was less than 100 kcal for 39 of all 43patients. Conclusions: Among the three alternative methods, HBE was the most reliable for estimating BEE in LT recipients.
Collapse
Affiliation(s)
| | - Marcio F Chedid
- Postgraduate Program in Surgical Sciences.,Division of Gastrointestinal Surgery and Liver and Pancreas Transplantation
| | | | | | | | - Luciano S Guimarães
- Division of Medical Statistics, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | - Ian Leipnitz
- Division of Gastrointestinal Surgery and Liver and Pancreas Transplantation
| | - Aljamir D Chedid
- Division of Gastrointestinal Surgery and Liver and Pancreas Transplantation
| | - Cleber R P Kruel
- Postgraduate Program in Surgical Sciences.,Division of Gastrointestinal Surgery and Liver and Pancreas Transplantation
| | | | - Cleber D P Kruel
- Postgraduate Program in Surgical Sciences.,Division of Gastrointestinal Surgery and Liver and Pancreas Transplantation
| |
Collapse
|
13
|
Fernandes SA, de Mattos AA, Tovo CV, Marroni CA. Nutritional evaluation in cirrhosis: Emphasis on the phase angle. World J Hepatol 2016; 8:1205-1211. [PMID: 27803765 PMCID: PMC5067440 DOI: 10.4254/wjh.v8.i29.1205] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/05/2016] [Accepted: 08/18/2016] [Indexed: 02/06/2023] Open
Abstract
Protein-calorie malnutrition (PCM) is a common condition in cirrhotic patients, leading to a worse prognosis, complications, poor quality of life and lower survival rates. Among ways of assessing nutritional status, there are anthropometric methods such as the evaluation of the triceps skinfold, the arm circumference, the arm muscle circumference and the body mass index, and non-anthropometric methods such as the subjective global assessment, the handgrip strength of non-dominant hand, and the bioelectrical impedance analysis (BIA). PCM is frequently under-diagnosed in clinical settings in patients with cirrhosis due to the limitations of nutritional evaluation methods in this population. BIA is a useful method, but cannot be indicated in patients with abnormal body composition. In these situations, the phase angle (PA) has been used, and can become an important tool in assessing nutritional status in any situation. The PA is superior to anthropometric methods and might be considered as a nutritional indicator in cirrhosis. The early characterization of the nutritional status in patients with cirrhosis means an early nutritional intervention, with a positive impact on patients’ overall prognosis. Among the usually accepted methods for nutritional diagnosis, the PA provides information in a quick and objective manner.
Collapse
|
14
|
Marroni CA, Miranda D, Boemeke L, Fernandes SA. Phase Angle Bioelectrical Impedance Analysis (BIA) as a Biomarker Tool for Liver Disease. BIOMARKERS IN DISEASE: METHODS, DISCOVERIES AND APPLICATIONS 2016:1-18. [DOI: 10.1007/978-94-007-7742-2_43-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
|
15
|
Silveira TMG, Sousa JBD, Stringhini MLF, Freitas ATVDS, Melo PG. Nutritional assessment and hand grip strength of candidates for surgery of the gastrointestinal tract. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27:104-8. [PMID: 25004287 PMCID: PMC4678683 DOI: 10.1590/s0102-67202014000200005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 03/11/2014] [Indexed: 11/29/2022]
Abstract
Background The assessment of nutritional status in clinical practice must be done with
simple, reliable, low cost and easy performance methods. The power of handshake is
recognized as a useful tool to evaluate muscle strength, and therefore, it is
suggested that can detect malnutrition. Aim To evaluate the nutritional status by subjective global assessment and power of
handshake preoperatively in patients going to gastrointestinal surgeries and to
compare the diagnosis obtained by subjective global assessment with traditional
anthropometric methods and power of handshake. Methods A cross-sectional study was conducted with patients for surgery in the
gastrointestinal tract and related organs. Socioeconomic and anthropometric data,
applied to subjective global assessment and checked the power of handshake, were
collected. The force was obtained by the average of three measurements of the
dominant and non-dominant hand and thus compared with reference values of the
population by sex and age, for the classification of nutritional risk. Results The sample consisted of 40 patients, 24-83 years, and most women (52.5%)
housewives (37,5%) and diagnosed with cancer (45%). According to subjective global
assessment, 37.5% were classified as moderately malnourished; 15% were underweight
by BMI measurements; 25% had arm circumference at risk for malnutrition
(<percentil 5); 60% reported recent weight loss; and 37.5% low clamping force
in power of handshake on non-dominant hand (left). Conclusion A significant association was observed for the diagnosis of nutritional subjective
assessment with anthropometric methods and strength of the handshake only at the
non-dominant limb.
Collapse
|
16
|
Abstract
Liver transplantation (LT) is a major surgery performed on patients with end stage liver disease. Nutrition is an integral part of patient care, and protein-energy malnutrition is almost universally present in patients suffering from liver disease undergoing LT. Nutrition assessment of preliver transplant phase helps to make a good nutrition care plan for the patients. Nutrition status has been associated with various factors which are related to the success of liver transplant such as morbidity, mortality, and length of hospital stay. To assess the nutritional status of preliver transplant patients, combinations of nutrition assessment methods should be used like subjective global assessment, Anthropometry mid arm-muscle circumference, Bioelectrical impedance analysis (BIA) and handgrip strength.
Collapse
Affiliation(s)
- Neha Bakshi
- Lady Irwin College, Department of Foods and Nutrition, University of Delhi, New Delhi, India
| | - Kalyani Singh
- Lady Irwin College, Department of Foods and Nutrition, University of Delhi, New Delhi, India
| |
Collapse
|
17
|
Vulcano DSB, Carvalhaes MADBL, Bakonyi Neto A. Evaluation of nutritional indicators and body composition in patients with advanced liver disease enrolled for liver transplantation. Acta Cir Bras 2014; 28:733-9. [PMID: 24114303 DOI: 10.1590/s0102-86502013001000008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 09/10/2013] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Malnutrition is prevalent in patients with advanced liver disease (LD) related to multifactorial causes. Fluid retention can underestimate the nutritional status based on anthropometric measures. We evaluated nutritional indicators and body composition (BC) in patients with liver cirrhosis and correlated them with LD severity. METHODS Forty three patients with LD enrolled for liver transplantation were evaluated by Anthropometric measures, subjective evaluation (Global Assessment of Nutritional Status - SGA) and biochemical indicators. Single-frequency electrical bioimpedance (SFE-BIA) was used to evaluate body composition (BC). It measured resistance (R), reactance (Xc) and the phase angle (PA). LD severity was estimated by Child-Pugh and Meld criteria (Model for End-Stage Liver Disease). RESULTS Child-Pugh index between patients was 7.11 ± 1.70 and Meld was 12.23 ± 4.22. Arm Circumference, Arm Muscle Circumference and Arm Muscle Area, SGA, hemoglobin, hematocrit and albumin showed better correlation with disease severity. Xc and PA showed correlation both with Meld and Child-Pugh score when BC were evaluated. PA was depleted in 55.8% of the patients. CONCLUSIONS Diagnosis of malnutrition varied according to the method. Global assessment of nutritional status showed better correlation with disease severity than with objective methods. Single-frequency electrical bioimpedance for body composition analysis in cirrhotic patients must be cautiously used; however, primary vectors seems to be valid and promising in clinical practice.
Collapse
|
18
|
Garcia MF, Meireles MS, Führ LM, Donini AB, Wazlawik E. Relationship between hand grip strength and nutritional assessment methods used of hospitalized patients. REV NUTR 2013. [DOI: 10.1590/s1415-52732013000100005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: This study verified the association between hand grip strength and body mass index, subjective global assessment and nutritional risk screening 2002. METHODS: This cross-sectional study calculated the body mass index, measured hand grip strength and administered the subjective global assessment and nutritional risk screening 2002 to 118 patients hospitalized at the University Hospital of the Universidade Federal de Santa Catarina, Florianópolis, Brazil. Hand grip strength was compared with the reference values for the Brazilian population according to gender and age. The statistical analyses included the Student's t-test or Mann-Whitney test and multiple linear regression. The results were considered significant when p<0.05. RESULTS: The prevalences of nutritional risk or malnutrition according to body mass index, global subjective assessment, nutritional risk screening 2002 and hand grip strength were 3.5%, 50.9%, 33.9% and 35.6%, respectively. Malnourished individuals according to body mass index had, on average, 11.0kg less hand grip strength than the nourished individuals (p=0.008). There was no association between hand grip strength and the subjective global assessment (malnourished individuals had -2.8kg; p=0.078) and nutritional risk screening 2002 (malnourished individuals had -1.5kg; p=0.352). CONCLUSION: Hand grip strength was associated with body mass index but not with the subjective global assessment or nutritional risk screening 2002.
Collapse
|
19
|
Abstract
OBJECTIVE To evaluate the food intake, anthropometry, body composition, and sexual maturity of children and adolescents with autoimmune hepatitis. METHODS Thirty-seven children and adolescents with autoimmune hepatitis were studied. A questionnaire was given to evaluate food intake over a 24-hour period. Weight, height, and skin-fold thickness were measured. Electric impedance and skin-fold using Slaughter formula were used to evaluate body composition. Sexual maturity was evaluated using the Tanner stage method. Cumulative intake of corticosteroids was determined based on medical records. RESULTS Most of the subjects were females (83.3%). Food intake did not meet recommended dietary intakes for energy, calcium, and vitamin A for 43.2%, 94.6%, and 59.4% of the patients, respectively. All subjects were in their respective pubertal developmental stage. A lower Z score for height-for-age (<or-2.0 standard deviation) was found in 3/37 (10.5%) of the patients. Body fat over 30% was found in female patients by bioimpedance (41.9%) and skin-fold (45.2%) evaluation. There was a positive correlation between the 2 methods of measuring body fat (r=/+0.800; P<0.001). A larger reduction (P<0.005) in Z score for height-for-age was observed in patients that received a cumulative dose of corticosteroids of more than 10.0 g. CONCLUSIONS Food intake in children and adolescents with autoimmune hepatitis is below recommended standards especially for energy, calcium, and vitamin A. Cumulative dose of corticoids was associated with reduction of Z score for height-for-age.
Collapse
|
20
|
Bragança ACC, Álvares-da-Silva MR. Prevalence of diabetes mellitus and impaired glucose tolerance in patients with decompensated cirrhosis being evaluated for liver transplantation: the utility of oral glucose tolerance test. ARQUIVOS DE GASTROENTEROLOGIA 2010; 47:22-7. [DOI: 10.1590/s0004-28032010000100005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2008] [Accepted: 06/23/2009] [Indexed: 01/22/2023]
Abstract
CONTEXT: Cirrhosis, diabetes mellitus, impaired glucose tolerance, insulin resistance, and protein calorie malnutrition are important issues in cirrhotic patients because they can increase the progression of liver disease and worsen its prognosis. OBJECTIVE:To determine the prevalence of diabetes mellitus, impaired glucose tolerance and insulin resistance in cirrhotic patients being evaluated for liver transplantation and their impacts on a 3-month follow-up, and to compare fasting glycemia and oral glucose tolerance test. METHODS: A cross-sectional study was performed in consecutively included adult patients. Diabetes mellitus was established through fasting glycemia and oral glucose tolerance test in diagnosing diabetes mellitus in this population. HOMA-IR and HOMA-β indexes were calculated, and nutritional assessment was performed by subjective global assessment, anthropometry and handgrip strength through dynamometry. RESULTS: Diabetes mellitus was found in 40 patients (64.5%), 9 (22.5%) of them by fasting glycemia and 31 (77.5%) of them by oral glucose tolerance test. Insulin resistance was found in 40 (69%) of the patients. There was no relationship between diabetes mellitus and the etiology of cirrhosis. Protein calorie malnutrition was diagnosed in a range from 3.22% to 45.2% by anthropometry, 58.1% by subjective global assessment and 88.7% by handgrip strength. Diabetes mellitus identified by oral glucose tolerance test was related significantly to a higher prevalence of infectious complications and deaths in a 3-month period (P = 0.017). CONCLUSION: The prevalence of diabetes mellitus, impaired glucose tolerance, insulin resistance and protein calorie malnutrition is high in cirrhotic patients on the waiting list for liver transplantation. There were more infectious complications and/or deaths in a 3-month follow-up period in patients with diabetes mellitus diagnosed by oral glucose tolerance test. Oral glucose tolerance test seems to be indicated as a routine practice in this population.
Collapse
|
21
|
Bin CM, Flores C, Alvares-da-Silva MR, Francesconi CFM. Comparison between handgrip strength, subjective global assessment, anthropometry, and biochemical markers in assessing nutritional status of patients with Crohn's disease in clinical remission. Dig Dis Sci 2010; 55:137-44. [PMID: 19229617 DOI: 10.1007/s10620-008-0692-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2008] [Accepted: 12/29/2008] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Crohn's disease (CD) may lead to protein and calorie malnutrition (PCM) secondary to impaired digestive and absorptive functions of the small intestine and sometimes to the influence of diet taboos. The earlier the PCM is diagnosed, the higher are the odds of reversal. The objective of this study was to compare different methods of nutritional assessment in patients with CD and correlate them with the disease characteristics. SAMPLE The sample comprised 75 patients with CD from the Gastroenterology Service at the Hospital de Clínicas de Porto Alegre; 37 were male, with a mean age of 38.2 years old (SD = 13.3). All patients had been in clinical remission (CDAI <150) for over 3 months. They were not receiving enteral or parenteral nutrition. The nutritional assessment was considered: body mass index (BMI), triceps skin fold (TSF), arm circumference (MAC), arm muscle circumference (MAMC), subjective global assessment (SGA), non-dominating handgrip strength (HGS) and food intake inquiries. RESULTS When comparing the different nutritional assessment methods, 26.7% of the patients were malnourished according to the MAC, 29.3% according to the MAMC, 18.7% according to the SGA, 6.7% according to the BMI, 37.3% according to the TSF and 73.3% according to the HGS. No statistically significant associations were found for disease location, its behavior, drugs utilized, ESR, CRP, age of patients and disease time with the nutritional state verified by HGS, TSF, MAMC and SGA. CONCLUSION The prevalence of malnutrition is significant in patients with CD, even in clinical remission. The BMI should not be used as reference in this population. The HGS detected a high prevalence of nutritional risk in patients with CD in remission. Studies are required that correlate it with more sensitive methods, for the patients' effective nutritional state assessment.
Collapse
Affiliation(s)
- Céres Maltz Bin
- Universidade Federal do Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350, sala 2033, Porto Alegre, RS 90430-000, Brazil
| | | | | | | |
Collapse
|
22
|
Schneider ACR, Pinto RB, Silveira TRD. [Nutritional risk and malnutrition determination by anthropometry in cirrhotic children and adolescents]. ARQUIVOS DE GASTROENTEROLOGIA 2008; 44:345-9. [PMID: 18317655 DOI: 10.1590/s0004-28032007000400012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND The malnutrition is a frequent finding in adults with cirrhosis, but the prevalence of nutritional risk and malnutrition is little known in pediatric patients. AIM To evaluate through anthropometry the presence of nutritional risk and malnutrition in cirrhotic pediatric patients regularly attended at the Pediatric Gastroenterology Service of "Hospital de Clínicas" of Porto Alegre, RS, Brazil. METHODS Cross-sectional study with 42 cirrhotic children and adolescents aged between 3 months and 18 years. The nutritional evaluation was made by the determination of the weight/age, height/age, body mass index and triceps skinfold thickness and arm muscle circumference measurements. Patients considered in nutritional risk were < or = -1,28 Z score which corresponds to < or = 10th percentile, and those under -2,0 Z and < or = 3th percentile were in malnutrition status. According to Child-Pugh criteria, 22 patients were classified as A (mild severity), 15 (moderate) B and 5 C (intense). RESULTS The mean weight/age, height/age and body mass index Z scores were, respectively, - 0,38 +/- 1,4 SD, - 0,83 +/- 1,16 SD and 0,17 +/- 1,3 SD. Patients in nutritional risk were 3/42 (weight/age), 8/42 (height/age), 12/37 (triceps skinfold thickness), 9/37 (arm muscle circumference), 2/38 (body mass index); in malnutrition status were 6/42 (weight/age), 7/42 (height/age), 4/37 (triceps skinfold thickness) and 4/37 (arm muscle circumference) and 3/38 (body mass index). CONCLUSION The prevalence of nutritional risk was 32.4% and chronic malnutrition was 16.7%. The index which better reflected the nutritional risk in these patients was triceps skinfold thickness. Chronic malnutrition status occurrence was greater in the height/age index.
Collapse
Affiliation(s)
- Ana Cláudia Reis Schneider
- Setor de Gastroenterologia Pediátrica, Departamento de Pediatria do Hospital de Clínicas de Porto Alegre, RS, Brazil
| | | | | |
Collapse
|
23
|
Budziareck MB, Pureza Duarte RR, Barbosa-Silva MCG. Reference values and determinants for handgrip strength in healthy subjects. Clin Nutr 2008; 27:357-62. [PMID: 18455840 DOI: 10.1016/j.clnu.2008.03.008] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2007] [Revised: 03/16/2008] [Accepted: 03/21/2008] [Indexed: 12/31/2022]
|
24
|
Ritter L, Gazzola J. [Nutritional evaluation of the cirrhotic patient: an objective, subjective or multicompartmental approach?]. ARQUIVOS DE GASTROENTEROLOGIA 2006; 43:66-70. [PMID: 16699622 DOI: 10.1590/s0004-28032006000100016] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Malnutrition due to liver disease is common and its assessment is difficult. The parameters of nutritional evaluation often used in clinical practice have limited use in cirrhotic patients. Many of the clinical signs of malnutrition are the result of the underlying hepatic disease which tends to confound and alter the nutritional diagnosis. AIM To present a brief review of the different methods of nutritional evaluation together with their limitations and uses in cirrhotic patients. CONCLUSION The multicompartmental approach for four compartments was shown to be considerably sensitive in the detection of malnutrition. However the ample use of this method is impaired due to technical difficulties and high costs. The handgrip strength appears to be a simple, cheap and effective alternative to detected malnutrition and risk of malnutrition in these patients. Is the most sensitive method and is able to predict a significant incidence of major complications in undernourished cirrhotic patients.
Collapse
|
25
|
Barbosa-Silva MCG, Barros AJD. Indications and limitations of the use of subjective global assessment in clinical practice: an update. Curr Opin Clin Nutr Metab Care 2006; 9:263-9. [PMID: 16607126 DOI: 10.1097/01.mco.0000222109.53665.ed] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Subjective global assessment is a clinical tool for assessing nutritional status that merges alterations in body composition and physiological function. Although it was first described almost two decades ago, many studies using this method have been published during the past few years. This review describes recent findings from such studies. RECENT FINDINGS Subjective global assessment has proved to be a good nutritional assessment and prognostic indicator in several clinical situations. Agreement between subjective global assessment and newer screening methods is not always acceptable, and it has not been validated with respect to clinical outcome. Some modifications have been suggested that may increase the sensitivity of subjective global assessment as a screening tool. A scored version of subjective global assessment for cancer patients is now being validated for use in other patient groups. This could increase its utility in nutritional intervention studies if it can be demonstrated that subtle changes in nutritional status are reflected by numerical scores in patient-generated subjective global assessment. SUMMARY Subjective global assessment represents a good option for assessing nutritional status in various clinical situations. As a screening tool, it better identifies established malnutrition than nutritional risk but its sensitivity is suboptimal. The scored version of subjective global assessment may have advantages and extend the usefulness of this tool even further.
Collapse
|
26
|
|