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Ann Clin Nutr Metab : Annals of Clinical Nutrition and Metabolism

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Review Article
Nutritional Management in Patients with Liver Dysfunction
Tae Hee Lee
Surg Metab Nutr 2017;8(1):1-6.   Published online June 30, 2017
DOI: https://doi.org/10.18858/smn.2017.8.1.1
AbstractAbstract PDFePub

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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Original Article
Analysis of Current Use of Early Parenteral Nutrition and Clinical Significance of Non-protein Calorie: Nitrogen in Surgical Critically Ill Patients
Eunjeong Heo, Kayoung Park, Sujeong Jeon, Hyungwook Namgung, Eunsook Lee, Inae Song
J Clin Nutr 2015;7(3):75-80.   Published online December 31, 2015
DOI: https://doi.org/10.15747/jcn.2015.7.3.75
AbstractAbstract PDFePub

Purpose:

Surgical critically ill patients require adequate nutrition support and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) guidelines recommend low non-protein calorie:nitrogen ratio (NPC:N ratio, 70∼100) for critically ill pateints. In this study, we assess the current use of early parenteral nutrition of surgical critically ill patients and analyze the clinical significance of NPC:N.

Methods:

This is a retrospective study of critically ill adult patients who remained in the intensive care unit (ICU) for over 3 days and could not receive enteral nutrition for the first 7 days. Data on parenteral intake of patients were collected from electronic medical records. Association of NPC:N scores with clinical outcome (length of ICU stay, length; of hospital stay, duration of ventilation, and mortality) were analyzed using Pearson correlation and multiple regression.

Results:

The study included 72 cases, average parenteral calorie intake was 14.6 kcal/kg/day and protein intake was 0.5 g/kg/day. We assessed the NPC:N scores to determine the patients’ NPC:N for the first 7 days in ICU close to the A.S.P.E.N guidelines. NPC:N scores showed weak negative correlation with length of hospital stay and duration of mechanical ventilation (r=−0.259, P=0.028; r=−0.495, P=0.001). Multiple regression adjusted with APACHE (Acute Physiology and Chronic Health Evaluation) II score, age, and body mass index showed correlation of higher NPC:N score with decreased length of hospital stay and shorter duration of ventilation (P=0.0001, P=0.035, respectively). However, length of ICU stay and mortality within 60 days showed no significant correlation with NPC:N scores.

Conclusion:

Parenteral calories and protein intakes of critically ill patients in ICU were lower in comparison to A.S.P.E.N. recommendation in this study. Low NPC:N scores might be related to shorter length of hospital stay, duration of mechanical ventilation. Consultation of a nutritional support team could have a positive effect in providing appropriate nutrition support.

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