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©2014 Baishideng Publishing Group Inc.
World J Gastroenterol. Aug 21, 2014; 20(31): 10682-10690
Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10682
Published online Aug 21, 2014. doi: 10.3748/wjg.v20.i31.10682
Table 1 Prevalence of muscle depletion in cirrhotic patients and related outcomes
Ref. | Patients (n) | Definition of muscle depletion | Prevalence of muscle depletion | Outcome associated with muscle depletion |
Merli et al[5], 1996 | 1053 | Mid Arm Muscle Area < 5thP | 26% | Lower survival in Child A and Child B |
38% M; 8% F | ||||
Alberino et al[13], 2001 | 212 | Mid Arm Muscle Area < 5thP | 25% | Lower survival at 6, 12 and 24 mo |
Mid Arm Muscle Area < 10thP | 37% | |||
Alvares-da-Silva et al[14], 2005 | 50 | Hand-Grip Strength 2 SDs below the mean value for the controls | 63% | Higher rate of major complications |
Campillo et al[15], 2006 | 396 | Mid Arm Muscle Area < 5thP | 53.2% | No correlation with in-hospital mortality |
Child Pugh A: | ||||
74.3% M, 22.2% F; | ||||
Child Pugh B: | ||||
68.9% M, 35.2% F; | ||||
Child Pugh C: | ||||
54.7% M, 21.9% F | ||||
Peng et al[16], 2007 | 268 | Protein Index < 0.82 or 2 SDs below the mean protein index for the controls | 51% | No outcome evaluated |
63% M; 28% F | ||||
Child Pugh A: 72%; | ||||
Child Pugh B: 43%; | ||||
Child Pugh C: 42% | ||||
Huisman et al[17], 2011 | 84 | Hand-Grip Strength | 67% | Higher risk of complications |
Mid Arm Muscle Circumference | 58% | |||
Fernandes et al[20], 2012 | 129 | Mid Arm Muscle Circumference | 13.2% | No outcome evaluated |
Hand-Grip Strength 2 SDs below the mean value for the controls | 69.3% | |||
Montano-Loza et al[18], 2012 | 112 | Lumbar Skeletal Muscle Mass Index at CT scan ≤ 38.5 cm2/m2 in women and ≤ 52.4 cm2/m2 in men | 40% | Increased 3 and 6 mo mortality |
50% M; 18% F | ||||
Child Pugh A: 13%; | ||||
Child Pugh B: 55%; | ||||
Child Pugh C: 32% | ||||
Tandon et al[19], 2012 | 142 | Lumbar Skeletal Muscle Mass Index at CT scan ≤ 38.5 cm2/m2 in women and ≤ 52.4 cm2/m2 in men | 41% | Increased mortality in cirrhotic patients awaiting liver transplantation |
54% M; 21% F | ||||
Child Pugh A: 0% M, 14% F; | ||||
Child Pugh B: 42% M, 21% F; | ||||
Child Pugh C: 72% M, 23% F | ||||
Merli et al[21], 2013 | 300 | Mid Arm Muscle Circumference < 5thP | 39% | Higher rate of hepatic encephalopathy |
Table 2 Mechanisms that cause a reduction in food intake in patients with cirrhosis
Reduced nutrient intake | Decreased appetite and anorexia | Unpalatable diet (sodium and water restriction for peripheral oedema and ascites, protein restriction for hepatic encephalopathy) |
Dysgeusia due to micronutrient deficiencies (zinc or magnesium) | ||
Anorexic effect caused by increased levels of proinflammatory cytokines (TNFα, IL-1β, IL-6) and leptin | ||
Nausea and early satiety | Tense ascites | |
Gastroparesis | ||
Small bowel dysmotility | ||
Bacterial overgrowth | ||
Frequent compulsory starvation | Hospitalisation | |
Invasive diagnostic procedures requiring fasting | ||
Gastrointestinal bleeding and endoscopic therapy |
Table 3 Vitamins and trace elements deficiencies in patients with cirrhosis
Mechanism of deficiency | Primary consequences | |
Water soluble vitamins | ||
Complex B and | Dietary insufficiency | Wernicke’s encephalopathy and Korsakoff dementia, anaemia, asthenia, scurvy |
Vitamin C | Intestinal dysmotility | |
Fat soluble vitamins | ||
Vitamin A (Retinol) and vitamin E | Dietary insufficiency | Risk factor for developing cancer, including hepatocellular carcinoma, night blindness |
Malabsorption for cholestasis or due to medications (i.e., cholestyramine) | ||
Vitamin D | Dietary insufficiency | Osteopenia and osteoporosis |
Malabsorption for cholestasis or due to medications (i.e., cholestyramine, steroids) | ||
Vitamin K | Reduced exposure to UV light | K-dependent coagulation factors deficiency (II, VII, IX, X) |
Dietary insufficiency | ||
Malabsorption for cholestasis or due to medications (i.e., cholestyramine) | ||
Trace elements | ||
Zinc | Dietary insufficiency | Contribution to impaired glucose tolerance and diabetes, precipitation of hepatic encephalopathy |
Malabsorption (intestinal dysmotility) | ||
Diuretic induced increased urinary excretion | ||
Magnesium | Dietary insufficiency | Loss of muscle strength |
Malabsorption (intestinal dysmotility) |
Table 4 Relationship between nutritional status and outcome after liver transplantation
Ref. | Patients (n) | Parameters used for the assessment of nutritional status | Prevalence of malnutrition | Outcomes related to malnutrition |
Pikul et al[64],1994 | 68 | Subjective Global Nutritional Assessment | 79% | Prolonged ventilator support |
Increased incidence of tracheostomy | ||||
More days in intensive care unit and hospital | ||||
Selberg et al[65], 1997 | 150 | Anthropometry | 41%-53% | Decreased 5-yr survival after liver transplantation |
Body composition analysis | ||||
Indirect calorimetry | ||||
Harrison et al[66], 1997 | 102 | Anthropometry | 79% | Higher risk of infections |
Dietary intake | ||||
Figueiredo et al[7], 2000 | 53 | Subjective Global Nutritional Assessment | 87% | More days in intensive care unit |
Hand-grip strength | Increased incidence of infections | |||
Body composition analysis | ||||
Stephenson et al[68], 2001 | 99 | Subjective Global Nutritional Assessment | 100% | Increased blood product requirement |
More days in hospital | ||||
Shahid et al[28], 2005 | 61 | Hand-grip strength | Not reported | No correlation |
Anthropometry | ||||
de Luis et al[69], 2006 | 31 | Subjective Global Nutritional Assessment | Not reported | No correlation |
Body composition analysis | ||||
Dietary intake | ||||
Merli et al[70], 2010 | 38 | Subjective Global Nutritional Assessment | 53% | More days in intensive care unit and hospital |
Anthropometry | Increased incidence of infections | |||
Indirect calorimetry | ||||
Dietary intake | ||||
Englesbe et al[71], 2010 | 163 | Psoas muscle area (CT evaluation) | Not reported | Decreased 1-yr survival |
- Citation: Giusto M, Lattanzi B, Di Gregorio V, Giannelli V, Lucidi C, Merli M. Changes in nutritional status after liver transplantation. World J Gastroenterol 2014; 20(31): 10682-10690
- URL: https://www.wjgnet.com/1007-9327/full/v20/i31/10682.htm
- DOI: https://dx.doi.org/10.3748/wjg.v20.i31.10682