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Liver Cirrhosis and Sarcopenia
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Hye Yeon Chon, Tae Hee Lee
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Ann Clin Nutr Metab 2022;14(1):2-9. Published online June 1, 2022
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DOI: https://doi.org/10.15747/ACNM.2022.14.1.2
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Abstract
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- Malnutrition is one of the most common complications in patients with liver cirrhosis. In previous studies, cirrhotic patients with severe malnutrition have been associated with higher morbidity and mortality rates before and after liver transplantation. Frailty and sarcopenia are phenotypes of severe malnutrition that have been associated with complications requiring hospitalization or mortality during the wait for transplantation in patients with cirrhosis. Tools for evaluating frailty include the Activities of Daily Living scale, the Karnofsky Performance Status scale, and the Liver Frailty Index. Diagnosed by using computed tomography, sarcopenia is measured with the skeletal muscle index at L3 and is normalized by height. Nutritional status should be evaluated within the first 24~48 hours of hospitalization in every patient with cirrhosis. Among the various available screening tools, the Royal Free Hospital-Nutritional Prioritizing Tool proposed in the UK is recommended. Nutritional counseling with a multidisciplinary team is recommended to improve long-term survival in patients with cirrhosis. Multidisciplinary nutrition management should include evaluating nutritional status and providing guidance for achieving nutritional goals. Most guidelines suggest a calorie intake of 25~35 kcal/kg/day, and the recommended protein intake is 1.2~1.5 g/kg/day. One beneficial technique for patients is to divide the total recommended intake across four to five daily meals, including a nighttime snack. The principles of nutritional intervention in cirrhotic patients are not different from those in noncirrhotic patients. For improvement of sarcopenia, a strategic approach including physical activity and exercise, hormone replacement therapy, ammonia-lowering agents, and treatment of underlying liver disease is required.
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Nutritional Management in Patients with Liver Dysfunction
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Tae Hee Lee
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Surg Metab Nutr 2017;8(1):1-6. Published online June 30, 2017
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DOI: https://doi.org/10.18858/smn.2017.8.1.1
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Abstract
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Liver disease and nutritional status are known to affect each other. When liver disease is severe, patients become more malnourished and have a worse prognosis. Adequate nutritional support for patients with liver diseases can improve a patient’s condition and prognosis. In acute liver failure, malnutrition is uncommon, and the disease prognosis is determined within a short time. Patients with acute liver failure may survive and recover if they receive a transplant. Considerations should be given to the management of glucose intolerance and hyperammonemia. However, well-designed clinical trials are still lacking until now. In the case of liver cirrhosis, malnutrition may occur due to a variety of causes, and as in other diseases, oral or enteral nutrition is preferred to parenteral nutrition. Even if esophageal varices are present, it is possible to install a feeding tube. However, in the presence of ascites, PEG (percutaneous endoscopic gastrostomy) becomes contraindicated due to risk of complications. Calorie intake of 30~35 Kcal/kg/day and protein intake of 1.2 to 1.5 g/kg/day are appropriate. Protein restriction should not be necessary unless hepatic encephalopathy is severe. Late evening snacking and intake of branched chain amino acids can be helpful.
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