Therapeutic Effectiveness of Nutrition Therapy in Pediatric Patients with Chronic Liver Diseases Awaiting Liver Transplantation (original) (raw)
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Factors influencing malnutrition in children waiting for liver transplants
The American Journal of Clinical Nutrition
Nutrition deficiencies are common in children with chronic liver disease. To determine whether age, hepatic dysfunction, or energy intake influences this malnutrition, we evaluated the nutritional status of 49 children aged 2.5 mo to 13 y (mean: 35 mo; median: 12 mo). The children were divided into two groups according to age: group 1-29 patients aged 1 y (mean: 7 mo; median: 7 mo); and group 2-20 patients > 1 y (mean: 75 mo; median: 59 mo). Hepatic dysfunction was defined according to the Malatack criteria. Seventy-two-hour dietary intakes were recorded by a nutritionist.
Korean Journal of Transplantation, 2021
Background: Undernourishment was associated with the high-risk factor of post-transplantation infection, mortality, mobility and length of hospital stay after pediatric liver transplant. Methods: The study described the integrated nutrition therapies for the patient by phases of transplantation. The case study was a 14-year-old girl was with primary biliary cirrhosis and gastrointestinal bleeding, esophageal varices in 108 Military Central Hospital, Vietnam. Her nutritional status was assessed by small for gestational age (SGA), BMI-forage (BAZ), and middle-upper-arm-circumference (MUAC). Results: Before the transplant, the patient's SGA was C, BAZ-1.63 SD, and MUAC 18.5 cm. She loss of appetite and anorexia. Dietitian used a combination of enteral and parenteral feeding for the patient to achieve the recommended intake. Her weight was stable until the surgery day. In the early post-transplant period, dietitians used both enteral and parenteral nutrition. The liquid diet with rice and water was applied on day 2 and day 3, 6-time per day, 50 mL each. From day 4 to day 7, she had nausea, vomit, and appetite disorder. The sum of energy was 900 kcal, with 1.7 g/kg of protein. From day 8, she felt less anorexia and vomiting. The oral nutrition increased gradually with four meals with porridge, and two formulas enriched BCAA. The total energy was 1,582.7 kcal, and she received 1.6 g/kg protein. SGA was B-level. From day 14, the intake of protein increased to 2.3 g/kg, with sources from beans, poultry, egg, fish, and vegetables. The six-meal diet was maintained (soups, rice, and formulas). From day 21, the protein diet at 2.4 g/kg was maintained. Sixty days after transplant, the liver function improved, the patient gained 37.5 kg, SGA B, BAZ-1.56 SD, and MUAC 20.0 cm. Conclusions: Nutrition management planning based on three stages of liver transplantation was essential for pediatric patients. The suitable diet with the patient's eating habits showed positive effects on liver function and improved the children's nutritional status.
Metabolic and Nutritional Repercussions of Liver Disease on Children: How to Minimize Them?
Revista Paulista de Pediatria
Objective: To describe the metabolic and nutritional repercussions of chronic liver disease (CLD), proposing strategies that optimize nutritional therapy in the pre- and post-liver transplantation (LT) period, in order to promote favorable clinical outcomes and adequate growth and development, respectively. Data sources: Bibliographic search in the PubMed, Lilacs and SciELO databases of the last 12 years, in English and Portuguese; target population: children from early childhood to adolescence; keywords in Portuguese and their correlates in English: “Liver Transplant,” “Biliary Atresia,” “Nutrition Therapy,” “Nutritional Status,” and “Child”; in addition to Boolean logics “and” and “or,” and the manual search of articles. Data synthesis: Malnutrition in children with CLD is a very common condition and an important risk factor for morbidity and mortality. There is an increase in energy and protein demand, as well as difficulties in the absorption of carbohydrates, lipids and micronu...
Nutritional Needs and Support for Children with Chronic Liver Disease
Nutrients, 2017
Malnutrition has become a dangerously common problem in children with chronic liver disease, negatively impacting neurocognitive development and growth. Furthermore, many children with chronic liver disease will eventually require liver transplantation. Thus, this association between malnourishment and chronic liver disease in children becomes increasingly alarming as malnutrition is a predictor of poorer outcomes in liver transplantation and is often associated with increased morbidity and mortality. Malnutrition requires aggressive and appropriate management to correct nutritional deficiencies. A comprehensive review of the literature has found that infants with chronic liver disease (CLD) are particularly susceptible to malnutrition given their low reserves. Children with CLD would benefit from early intervention by a multi-disciplinary team, to try to achieve nutritional rehabilitation as well as to optimize outcomes for liver transplant. This review explains the multifactorial ...
Optimizing Nutritional Management in Children with Chronic Liver Disease
Pediatric Clinics of North America, 2009
The liver plays a central role in energy and nutrient metabolism. Liver disease results in complex pathophysiologic disturbances affecting nutrient digestion, absorption, distribution, storage, and use. In children, chronic liver disease (CLD) is most commonly cholestatic in nature and include such conditions as biliary atresia, a 1-antitrypsin deficiency, Alagille syndrome, and progressive familial intrahepatic cholestasis (Box 1). Malnutrition in children with CLD is often underrecognized, because the clinical assessment of nutritional status with such parameters as weight-forage , heightfor-age, and weight-for-height percentiles frequently overestimates nutritional adequacy. High energy and growth requirements make infants and children with CLD particularly vulnerable to the debilitating effects of malnutrition. For those patients with end-stage liver disease awaiting liver transplantation (LT), malnutrition is associated with poorer outcomes, including increased risks for pre-and post-LT morbidity and mortality, 1-3 poorer neurocognitive development, 4,5 and growth even after LT. 6 This article reviews the pathophysiology of malnutrition in pediatric CLD and provides an approach to the assessment, diagnosis, and treatment of the most commonly seen nutritional deficiencies in children with CLD.
Diet quality of children post-liver transplantation does not differ from healthy children
Pediatric Transplantation, 2017
Little has been studied regarding the diets of children following LTX. The study aim was to assess and compare dietary intake and DQ of healthy children and children post-LTX. Children and adolescents (2-18 years) post-LTX (n=27) and healthy children (n=28) were studied. Anthropometric and demographic data and two 24-hour recalls (one weekend; one weekday) were collected. Intake of added sugar, HFCS, fructose, GI, and GL was calculated. DQ was measured using three validated DQ indices: the HEI-C, the DGI-CA, and the DQI-I. Although no differences in weight-forage z-scores were observed between groups, children post-LTX had lower height-forage z-scores than healthy children (P<.01). With the exception of vitamin B12, no significant differences in energy and macronutrient (protein, carbohydrate, and fat), added sugar, HFCS, fructose, GI, GL, and micronutrient intakes and DQ indices (HEI-C, DGI-CA, and DQI-I) between groups were observed (P>.05). The majority of children in both groups (>40%) had low DQ scores. No significant interrelationships between dietary intake, anthropometric, and demographic were found (P>.05). Both healthy and children post-LTX consume diets with poor DQ. This has implications for risk of obesity and metabolic dysregulation, particularly in transplant populations on immunosuppressive therapies.
HepatoBiliary Surgery and Nutrition, 2016
Background: Malnutrition is highly prevalent in patients undergoing liver transplantation and has been associated to various clinical variables and outcome of the surgery. Methods: We recruited 54 adult patients undergoing living donor liver transplant (LT) as study sample. Nutrition assessment was performed by body mass index (BMI), BMI for ascites, albumin, subjective global assessment (SGA) and anthropometry [mid upper arm circumference (MUAC), mid arm muscle circumference (MAMC), and triceps skin-fold (TSF)], Hand Grip strength, and phase angle of the body. Prevalence and comparison of malnutrition was performed with various clinical variables: aetiology, Child Turcotte Pugh scores and model for end stage liver disease (ESLD) grades, degree of ascites, blood product usage, blood loss during the surgery, mortality, days [intensive care unit (ICU), Ventilator and Hospital], and Bio-impedance analysis [weight, fat mass, fat free mass (FFM), muscle mass and body fat%]. Results: Assessment of nutrition status represents a major challenge because of complications like fluid retention, hypoalbuminemia and hypoproteinemia. Different nutrition assessment tools show great disparity in the level of malnutrition among ESLD patients. In the present study recipient nutrition status evaluation by different nutrition assessment tools used showed malnutrition ranging from 3.7% to 100%. BMI and anthropometric measurements showed lower prevalence of malnutrition than phase angle and SGA whereas hand grip strength showed 100% malnutrition. Agreement among nutrition assessment methods showed moderate agreement (κ=0.444) of SGA with phase angle of the body. Malnutrition by different assessment tools was significantly associated to various clinical variables except MELD and days (ICU, Ventilator and Hospital). SGA was significantly (P<0.05) associated to majority of the clinical variables like aetiology, child Turcotte Pugh grades, degree of ascites, blood product usage , blood loss during the surgery, BIA (fat mass, FFM, muscle mass and body fat%). Conclusions: The different nutrition assessment tools showed great variability of results. SGA showed moderate agreement with phase angle of the body and was associated with various clinical and prognostic variables of liver transplantation.
Nutrition of Liver Transplant Patients
The Canadian journal of gastroenterology, 2000
N utritional status has been shown to be an important prognostic factor in patients with end-stage liver disease undergoing liver transplantation (1-7). In these patients, malnutrition may be related to poor nutritional intake, malabsorption and liver disease itself. Muscle wasting, fat store depletion, impaired immunological function, and decreased vitamin and trace element serum levels may influence patient outcome by prolonging catabolic state, increasing risk of septic complications, and causing long term weaning and intensive care unit stay (8,9). However, there are no detailed clinical guidelines and recommendations with regard to the perioperative nutrition of the liver transplant patient. Only limited data from controlled studies are available, which may well be attributed to transplant units placing a