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Bruns N, Meyer F, Rischmüller K, Frost F, Tran QT, Ittermann T, Bahls M, Valentini L, Lamprecht G, Lerch MM, Aghdassi AA, Wiese ML. Nutritional status in patients with chronic pancreatitis and liver cirrhosis is related to disease conditions and not dietary habits. Sci Rep 2024; 14:4700. [PMID: 38409360 PMCID: PMC10897307 DOI: 10.1038/s41598-024-54998-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 02/19/2024] [Indexed: 02/28/2024] Open
Abstract
Malnutrition is a common complication of chronic pancreatitis (CP) and liver cirrhosis (LC). Inadequate food intake is considered a relevant driver of malnutrition in both entities. However, the contribution of habitual diet to impaired nutritional status is unclear. In a prospective, multicenter cross-sectional study, we recruited patients with confirmed CP or LC and healthy volunteers as a control group. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition criteria. We comprehensively investigated habitual dietary intake on nutrient, food group, and dietary pattern level applying two validated food frequency questionnaires. We included 144 patients (CP: n = 66; LC: n = 78) and 94 control subjects. Malnutrition was prevalent in 64% and 62% of patients with CP or LC, respectively. In both CP and LC, despite slightly altered food group consumption in malnourished and non-malnourished patients there were no differences in energy or nutrient intake as well as dietary quality. Compared to controls patients showed distinct dietary food group habits. Patients consumed less alcohol but also lower quantities of fruits and vegetables as well as whole grain products (p < 0.001, respectively). Nevertheless, overall dietary quality was comparable between patients and healthy controls. Nutritional status in CP and LC patients is rather related to disease than habitual dietary intake supporting the relevance of other etiologic factors for malnutrition such as malassimilation or chronic inflammation. Despite distinct disease-related differences, overall dietary quality in patients with CP or LC was comparable to healthy subjects, which suggests susceptibility to dietary counselling and the benefits of nutrition therapy in these entities.
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Affiliation(s)
- Niklas Bruns
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Fatuma Meyer
- Institute of Evidence-Based Dietetics (NIED), University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Karen Rischmüller
- Division of Gastroenterology, Department of Medicine II, Rostock University Medical Center, Rostock, Germany
| | - Fabian Frost
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Quang Trung Tran
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - Till Ittermann
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Martin Bahls
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany
| | - Luzia Valentini
- Institute of Evidence-Based Dietetics (NIED), University of Applied Sciences Neubrandenburg, Neubrandenburg, Germany
| | - Georg Lamprecht
- Division of Gastroenterology, Department of Medicine II, Rostock University Medical Center, Rostock, Germany
| | - Markus M Lerch
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
- LMU University Hospital, Ludwig Maximilian Universität München, Munich, Germany
| | - Ali A Aghdassi
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Mats L Wiese
- Department of Medicine A, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
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2
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Santangeli E, Abbati C, Chen R, Di Carlo A, Leoni S, Piscaglia F, Ferri S. Pathophysiological-Based Nutritional Interventions in Cirrhotic Patients with Sarcopenic Obesity: A State-of-the-Art Narrative Review. Nutrients 2024; 16:427. [PMID: 38337711 PMCID: PMC10857546 DOI: 10.3390/nu16030427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 01/23/2024] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
In recent decades, following the spread of obesity, metabolic dysfunction has come to represent the leading cause of liver disease. The classical clinical presentation of the cirrhotic patient has, therefore, greatly changed, with a dramatic increase in subjects who appear overweight or obese. Due to an obesogenic lifestyle (lack of physical activity and overall malnutrition, with an excess of caloric intake together with a deficit of proteins and micronutrients), these patients frequently develop a complex clinical condition defined as sarcopenic obesity (SO). The interplay between cirrhosis and SO lies in the sharing of multiple pathogenetic mechanisms, including malnutrition/malabsorption, chronic inflammation, hyperammonemia and insulin resistance. The presence of SO worsens the outcome of cirrhotic patients, affecting overall morbidity and mortality. International nutrition and liver diseases societies strongly agree on recommending the use of food as an integral part of the healing process in the comprehensive management of these patients, including a reduction in caloric intake, protein and micronutrient supplementation and sodium restriction. Based on the pathophysiological paths shared by cirrhosis and SO, this narrative review aims to highlight the nutritional interventions currently advocated by international guidelines, as well as to provide hints on the possible role of micronutrients and nutraceuticals in the treatment of this multifaceted clinical condition.
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Affiliation(s)
- Ernestina Santangeli
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (E.S.); (C.A.); (R.C.); (F.P.)
| | - Chiara Abbati
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (E.S.); (C.A.); (R.C.); (F.P.)
| | - Rusi Chen
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (E.S.); (C.A.); (R.C.); (F.P.)
| | - Alma Di Carlo
- Division of Internal Medicine, Hepatobiliary and Immunoallergologic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.D.C.); (S.L.)
| | - Simona Leoni
- Division of Internal Medicine, Hepatobiliary and Immunoallergologic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.D.C.); (S.L.)
| | - Fabio Piscaglia
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy; (E.S.); (C.A.); (R.C.); (F.P.)
- Division of Internal Medicine, Hepatobiliary and Immunoallergologic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.D.C.); (S.L.)
| | - Silvia Ferri
- Division of Internal Medicine, Hepatobiliary and Immunoallergologic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy; (A.D.C.); (S.L.)
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3
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Topan MM, Sporea I, Dănilă M, Popescu A, Ghiuchici AM, Lupușoru R, Șirli R. Association between Dietary Habits and Sarcopenia in Patients with Liver Cirrhosis. J Clin Med 2023; 12:4693. [PMID: 37510811 PMCID: PMC10380646 DOI: 10.3390/jcm12144693] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/12/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
Sarcopenia and sarcopenic obesity are frequent complications of cirrhosis, and the dietary patterns of patients with these diseases significantly impact the development of both conditions. This study aims to evaluate the adequacy of the dietary intake of patients with liver cirrhosis. A total of 201 patients with liver cirrhosis were included in this analysis. We evaluated the nutritional status of the patients as stated by EWGSOP2 criteria. Subjects were divided into three groups: non-sarcopenic, sarcopenic, and with sarcopenic obesity. We conducted a dietary assessment three times over nonconsecutive 24 h periods within a month. According to EWGSOP2 criteria, combining low handgrip strength with low skeletal muscle index, the prevalence of sarcopenia was 57.2%. Sarcopenic obesity was found in 25.3% of patients. In the sarcopenic group of patients, the energy intake was lower than the current recommendations. Regarding protein intake, the consumption was relatively low in both sarcopenia and sarcopenic obesity samples of patients (0.85 g/kg body weight and 0.77 g/kg BW, p < 0.0001). Patients had a median of 2-3 eating episodes daily, and they often missed late-evening snacks. In conclusion, diet quality in cirrhotic patients was relatively poor, and energy and protein intakes were lower than suggested.
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Affiliation(s)
- Mirabela-Madalina Topan
- Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ioan Sporea
- Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Mirela Dănilă
- Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Alina Popescu
- Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Ana-Maria Ghiuchici
- Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Raluca Lupușoru
- Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Center for Modeling Biological Systems and Data Analysis, Department of Functional Science, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
| | - Roxana Șirli
- Department of Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timisoara, Romania
- Advanced Regional Research Center in Gastroenterology and Hepatology, "Victor Babeș" University of Medicine and Pharmacy, 300041 Timișoara, Romania
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Parisse S, Carnevale S, Di Bartolomeo F, Poli E, Miceli F, Ferri F, Mischitelli M, Rocco B, Lai Q, Lucatelli P, Corona M, Mennini G, De Santis A, Rossi M, Muscaritoli M, Cantafora A, Ginanni Corradini S. A Low Daily Intake of Simple Sugars in the Diet Is Associated with Improved Liver Function in Cirrhotic Liver Transplant Candidates. Nutrients 2023; 15:nu15071575. [PMID: 37049416 PMCID: PMC10097197 DOI: 10.3390/nu15071575] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
(1) Background: We investigated, for the first time, whether dietary simple sugar intake affects MELD score changes over time in a cohort of cirrhotic liver transplant candidates. (2) Methods: the MELD score, dietary habits using a 3-day food diary, and visceral adipose tissue index (VATI) measured with CT scan were assessed in 80 consecutive outpatient cirrhotic patients at baseline, after counseling to follow current nutritional guidelines. The MELD score was reassessed after six months and the DELTA-MELD was calculated as the MELD at the second assessment minus the MELD at baseline. (3) Results: Compared with the baseline, the MELD score of cirrhotic patients at the end of the study was decreased, stable, or increased in 36%, 8% and 56% of patients, respectively. In separate multiple linear regression models, DELTA-MELD was positively and independently correlated with the daily intake of simple sugars expressed in g/kg body weight (p = 0.01) or as a percentage of total caloric intake (p = 0.0004) and with the number of daily portions of fruit, added sugar, jam, and honey (p = 0.003). These associations were present almost exclusively in patients with VATI above the median value. (4) Conclusions: In cirrhotic patients with high amounts of visceral adipose tissue the consumption of simple sugars and fructose should be limited to improve their clinical outcome.
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Affiliation(s)
- Simona Parisse
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Francesca Di Bartolomeo
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Edoardo Poli
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, 94800 Villejuif, France
| | - Francesca Miceli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Flaminia Ferri
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Monica Mischitelli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Bianca Rocco
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Quirino Lai
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy
| | - Pierleone Lucatelli
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Mario Corona
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Gianluca Mennini
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy
| | - Adriano De Santis
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Massimo Rossi
- General Surgery and Organ Transplantation Unit, Department of Surgery, Sapienza University of Rome, 00161 Rome, Italy
| | - Maurizio Muscaritoli
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Alfredo Cantafora
- Department of Translational and Precision Medicine, Sapienza University of Rome, 00185 Rome, Italy
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Caregiving Strain, family functioning, and effort to change diet for patients with gastrointestinal cancer: A cross-sectional descriptive study. Eur J Oncol Nurs 2023; 62:102264. [PMID: 36610289 DOI: 10.1016/j.ejon.2022.102264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 11/29/2022] [Accepted: 12/18/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Among patients with cancer, it has been found that the family system influences health-related behaviors and may promote a healthy diet. This study assessed the associations among cancer patients between family caregiver strain, family functioning, and efforts to change diet. METHODS This cross-sectional descriptive study was conducted in gastrointestinal outpatient units at two tertiary university hospitals in South Korea. This study included 401 main family caregivers of patients with gastrointestinal cancer. The caregivers were evaluated using structured, face-to-face questionnaires measuring family strain, family functioning, and effort to change diet. RESULTS Greater effort to change diet was associated with higher family functioning, having a spouse, and more caregiving time per week. Less effort to change diet was associated with greater levels of caregiving strain and with a son providing caregiving. CONCLUSION The efforts of family caregivers to alter diet are influenced by family strain and family functioning, as well as family caregivers' characteristics, such as marital status, health problems due to caregiving, care time and duration, and relationship with the patient. This study suggested that reducing family strain and improving family functioning in clinical settings facilitate the success to change dietary strategies for cancer families.
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Wrzosek L, Ciocan D, Hugot C, Spatz M, Dupeux M, Houron C, Lievin-Le Moal V, Puchois V, Ferrere G, Trainel N, Mercier-Nomé F, Durand S, Kroemer G, Voican CS, Emond P, Straube M, Sokol H, Perlemuter G, Cassard AM. Microbiota tryptophan metabolism induces aryl hydrocarbon receptor activation and improves alcohol-induced liver injury. Gut 2021; 70:1299-1308. [PMID: 33004548 DOI: 10.1136/gutjnl-2020-321565] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/20/2020] [Accepted: 09/02/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Chronic alcohol consumption is an important cause of liver-related deaths. Specific intestinal microbiota profiles are associated with susceptibility or resistance to alcoholic liver disease in both mice and humans. We aimed to identify the mechanisms by which targeting intestinal microbiota can improve alcohol-induced liver lesions. DESIGN We used human associated mice, a mouse model of alcoholic liver disease transplanted with the intestinal microbiota of alcoholic patients and used the prebiotic, pectin, to modulate the intestinal microbiota. Based on metabolomic analyses, we focused on microbiota tryptophan metabolites, which are ligands of the aryl hydrocarbon receptor (AhR). Involvement of the AhR pathway was assessed using both a pharmacological approach and AhR-deficient mice. RESULTS Pectin treatment modified the microbiome and metabolome in human microbiota-associated alcohol-fed mice, leading to a specific faecal signature. High production of bacterial tryptophan metabolites was associated with an improvement of liver injury. The AhR agonist Ficz (6-formylindolo (3,2-b) carbazole) reduced liver lesions, similarly to prebiotic treatment. Conversely, inactivation of the ahr gene in alcohol-fed AhR knock-out mice abrogated the beneficial effects of the prebiotic. Importantly, patients with severe alcoholic hepatitis have low levels of bacterial tryptophan derivatives that are AhR agonists. CONCLUSIONS Improvement of alcoholic liver disease by targeting the intestinal microbiota involves the AhR pathway, which should be considered as a new therapeutic target.
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Affiliation(s)
- Laura Wrzosek
- UMR996, Université Paris-Saclay, INSERM, Clamart, Île-de-France, France
| | - Dragos Ciocan
- UMR996, Université Paris-Saclay, INSERM, Clamart, Île-de-France, France.,Hepato-Gastroenterology and Nutrition, Antoine-Béclère Hospital, AP-HP, Clamart, Île-de-France, France
| | - Cindy Hugot
- UMR996, Université Paris-Saclay, INSERM, Clamart, Île-de-France, France
| | - Madeleine Spatz
- UMR996, Université Paris-Saclay, INSERM, Clamart, Île-de-France, France
| | - Margot Dupeux
- UMR996, Université Paris-Saclay, INSERM, Clamart, Île-de-France, France
| | - Camille Houron
- UMR996, Université Paris-Saclay, INSERM, Clamart, Île-de-France, France
| | | | - Virginie Puchois
- UMR996, Université Paris-Saclay, INSERM, Clamart, Île-de-France, France
| | - Gladys Ferrere
- UMR996, Université Paris-Saclay, INSERM, Clamart, Île-de-France, France
| | - Nicolas Trainel
- UMR996, Université Paris-Saclay, INSERM, Clamart, Île-de-France, France
| | - Françoise Mercier-Nomé
- Inserm, CNRS, Institut Paris Saclay d'Innovation thérapeutique, Paris-Saclay University, Chatenay-Malabry, Île-de-France, France
| | - Sylvere Durand
- Metabolomics and Cell Biology Platforms, Institut Gustave-Roussy, Villejuif, Île-de-France, France
| | - Guido Kroemer
- Metabolomics and Cell Biology Platforms, Institut Gustave-Roussy, Villejuif, Île-de-France, France.,U1138, INSERM, Paris, Île-de-France, France
| | - Cosmin Sebastian Voican
- UMR996, Université Paris-Saclay, INSERM, Clamart, Île-de-France, France.,Hepato-Gastroenterology and Nutrition, Antoine-Béclère Hospital, AP-HP, Clamart, Île-de-France, France
| | - Patrick Emond
- UMR 1253, iBrain, Université de Tours, Inserm, University of Tours, Tours, Centre-Val de Loire, France.,Service de Médecine Nucléaire In Vitro, CHRU Tours, Tours, Centre, France
| | - Marjolène Straube
- Centre de Recherche Saint-Antoine, CRSA, Sorbonne University, Paris, Île-de-France, France
| | - Harry Sokol
- Centre de Recherche Saint-Antoine, CRSA, Sorbonne University, Paris, Île-de-France, France.,Gastroenterology department, Saint-Antoine Hospital, AP-HP, Paris, Île-de-France, France
| | - Gabriel Perlemuter
- UMR996, Université Paris-Saclay, INSERM, Clamart, Île-de-France, France .,Hepato-Gastroenterology and Nutrition, Antoine-Béclère Hospital, AP-HP, Clamart, Île-de-France, France
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7
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Lee MK, Chung WJ. Relationship between symptoms and both stage of change in adopting a healthy life style and quality of life in patients with liver cirrhosis: a cross-sectional study. Health Qual Life Outcomes 2021; 19:148. [PMID: 34001156 PMCID: PMC8130318 DOI: 10.1186/s12955-021-01787-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 05/04/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Previous studies of patients with liver cirrhosis have not considered the broad range of symptoms or the association between healthy behavior and quality of life. The purposes of this study were to examine the association between symptoms and adopting exercise and consuming fruits and vegetables and to identify factors associated with quality of life in patients with liver cirrhosis. METHODS This cross-sectional study enrolled 91 consecutive patients with liver cirrhosis in one tertiary general hospital in South Korea between February 2016 and January 2017. Each study participant completed a self-administered questionnaire that measured symptom, stage of change in engaging in exercise and consumption of fruits and vegetables, and the Korean version of the 36-item Short-Form Health Survey. Multivariate ordinal logistic regression analysis and multiple regression models was used, respectively, to examine the association between each symptom with stage of change in engaging in exercise and consumption of fruits and vegetables and to evaluate factors affecting quality of life. RESULTS Experiencing nausea was associated with more readiness for change in engaging in exercise, but experiencing shortness of breath was associated with less readiness for change in engaging in exercise. Experiencing right upper quadrant pain was associated with more readiness for change in engaging in consumption of fruits and vegetables. Muscle cramps, anorexia, right upper quadrant pain and body pain, itching, ascites or edema, bruising, and change in appearance negatively affected quality of life. CONCLUSIONS The results suggest that the types of symptoms experienced by a patient with liver cirrhosis hinder or promote the patient's adoption of exercise and dietary behavior. Experiencing symptoms may negatively affect quality of life. Caregivers should provide supportive care to patients with liver cirrhosis, which includes assessing and managing symptoms to improve quality of life.
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Affiliation(s)
- Myung Kyung Lee
- College of Nursing, Research Institute of Nursing Science, Kyungpook National University, 41944, 680 Gukchabosangro, Jung-gu, Daegu, South Korea.
| | - Woo Jin Chung
- Department of Internal Medicine, Keimyung University School of Medicine, Daegu, South Korea
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8
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Georgiou A, Yannakoulia M, Papatheodoridis GV, Deutsch M, Alexopoulou A, Vlachogiannakos J, Ioannidou P, Papageorgiou MV, Voulgaris T, Papadopoulos N, Tsibouris P, Kontogianni MD. Assessment of dietary habits and the adequacy of dietary intake of patients with cirrhosis-the KIRRHOS study. Clin Nutr 2021; 40:3992-3998. [PMID: 34139472 DOI: 10.1016/j.clnu.2021.04.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS Undernutrition is widely prevalent in patients with cirrhosis and affects prognosis. Given the lack of data regarding the dietary intake (DI) and habits of patients with cirrhosis, the aim of the present study was to evaluate them by assessing diet's adequacy compared to the new guidelines, and the association of DI with nutritional status indicators. METHODS One hundred and eighty-seven patients (57.8% male, 59.9 ± 10.9 years old, 44.9% decompensated ones) with cirrhosis of various etiologies were enrolled. The patients' DI was assessed using three 24 h recalls, which were analyzed regarding macronutrients' intake, food groups consumption, adherence to the Mediterranean diet and meal patterns. The Goldberg cut-off limits for the ratio of energy intake to resting energy expenditure were used to evaluate dietary underreporting and patients were accordingly classified as low or adequate energy reporters (LERs and AERs). RESULTS Among the AERs (n = 91, 48.7%) only 29.7% and 31.9% met current recommendations regarding energy and protein intake, accordingly. Patients reported low intake of several healthy food groups and low adherence to the Mediterranean diet. They reported a median of 4.3 eating episodes per day and they frequently omitted late evening snack. Nevertheless, no statistically significant associations were found between parameters of DI and annual and two-year survival. CONCLUSIONS Low energy reporting was very frequent in this sample of patients with liver cirrhosis. Diet quality was rather poor, whereas energy and protein intakes were lower than those recommended.
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Affiliation(s)
- Alexandra Georgiou
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, 70 El.Venizelou Ave, 176 71, Kallithea, Greece
| | - Mary Yannakoulia
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, 70 El.Venizelou Ave, 176 71, Kallithea, Greece
| | - Georgios V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital of Athens, 17 Agiou Thoma Str., 115 27, Athens, Greece
| | - Melanie Deutsch
- 2nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 114 Vassilissis Sophias Ave, 115 27, Athens, Greece
| | - Alexandra Alexopoulou
- 2nd Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, 114 Vassilissis Sophias Ave, 115 27, Athens, Greece
| | - John Vlachogiannakos
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital of Athens, 17 Agiou Thoma Str., 115 27, Athens, Greece
| | - Panagiota Ioannidou
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital of Athens, 17 Agiou Thoma Str., 115 27, Athens, Greece
| | - Maria-Vasiliki Papageorgiou
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital of Athens, 17 Agiou Thoma Str., 115 27, Athens, Greece
| | - Theodoros Voulgaris
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital of Athens, 17 Agiou Thoma Str., 115 27, Athens, Greece
| | - Nikolaos Papadopoulos
- 1st Department of Internal Medicine, Army Share Fund Hospital of Athens, Vassilissis Sophias Ave & 10 Monis Petraki St, 115 21, Athens, Greece
| | - Panagiotis Tsibouris
- Department of Gastroenterology, Army Share Fund Hospital of Athens, Vassilissis Sophias Ave & 10 Monis Petraki St, 115 21, Athens, Greece
| | - Meropi D Kontogianni
- Department of Nutrition & Dietetics, School of Health Sciences and Education, Harokopio University, 70 El.Venizelou Ave, 176 71, Kallithea, Greece.
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