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Dtsch Med Wochenschr 2019; 144(18): 1267-1274
DOI: 10.1055/a-0753-6081
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© Georg Thieme Verlag KG Stuttgart · New York

Ernährung bei Leberzirrhose: wichtige Tipps für Klinik und Praxis

Nutrition in Liver Cirrhosis: Clinical Practice Recommendations
Mathias Plauth
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Publication History

Publication Date:
12 September 2019 (online)

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Abstract

Liver disease and nutritional status affect each other mutually. Hepatic function is impaired by malnutrition and can be improved by nutrition therapy. Liver cirrhosis leads to prognostically relevant malnutrition in a stage dependent manner. Protein depletion and sarcopenia are its key features. Patients with liver cirrhosis should undergo systematic screening for risk of malnutrition and if positive sarcopenia should be assessed and a nutrition plan devised. In cirrhotic patients, spontaneous food intake frequently does not meet requirements and prolonged (> 12 h) periods of fasting must be avoided. In a stepwise fashion nutritional counseling, oral nutritional supplements, enteral tube feeding and parenteral nutrition as third-line-therapy should be used. In cirrhotic patients, nutrition therapy can improve morbidity and mortality by ensuring the adequate provision of energy, protein and micronutrients.

Mangelernährung ist bei vielen Krankheiten ein unabhängiger Risikofaktor bezüglich Morbidität und Sterblichkeit. Zirrhosepatienten sind aufgrund von Eiweißmangel besonders gefährdet. Leberfunktionen werden durch Mangelernährung beeinträchtigt und können durch Ernährungstherapie wieder verbessert werden. Im nachfolgenden Beitrag werden die Bedeutung des Screenings auf Mangelernährung und die möglichen Therapien beleuchtet.

Schlüsselwörter

Enterale Ernährung - Parenterale Ernährung - Eiweißmangel - Sarkopenie - Gebrechlichkeit - Körperzusammensetzung

Key words

enteral nutrition - parenteral nutrition - protein malnutrition - sarcopenia - frailty - body composition
 

  • Literatur

  • 1 Council of Europe, Committee of Ministers. Resolution ResAP(2003)3 on food and nutritional care in hospitals. Im Internet: www.nutritionday.org ; Stand: 23.06.2019
    PubMed
  • 2 Peng S, Plank LD, McCall JL. et al. Body composition, muscle function, and energy expenditure in patients with liver cirrhosis: a comprehensive study. Am J Clin Nutr 2007; 85: 1257-1266
    CrossrefPubMedSearch in Google Scholar
  • 3 Plauth M, Schütz T, Pirlich M. et al. S3-Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESKES, der AKE und der DGVS. Klinische Ernährung in der Gastroenterologie (Teil 1) – Leber. Aktuel Ernahrungsmed 2014; 39: e1-e42
    Thieme ConnectPubMedSearch in Google Scholar
  • 4 Plauth M, Bernal W, Dasarathy S. et al. ESPEN guideline on nutrition in liver disease. Clin Nutr 2019; 38: 485-521
    CrossrefPubMedSearch in Google Scholar
  • 5 Selberg O, Böttcher J, Tusch G. et al. Identification of high- and low-risk patients before liver transplantation: a prospective cohort study of nutritional and metabolic parameters in 150 patients. Hepatology 1997; 25: 652-657
    CrossrefPubMedSearch in Google Scholar
  • 6 Tsien C, Garber A, Narayanan A. et al. Post-Liver Transplantation Sarcopenia in Cirrhosis: a Prospective Evaluation. J Gastroenterol Hepatol 2014; 29: 1250-1257
    CrossrefPubMedSearch in Google Scholar
  • 7 Montano-Loza AJ, Meza-Junco J, Prado CMM. et al. Muscle Wasting Is Associated With Mortality in Patients With Cirrhosis. Clin Gastroenterol Hepatol 2012; 10: 166-173
    CrossrefPubMedSearch in Google Scholar
  • 8 Lai JC, Dodge JL, Sen S. et al. Functional Decline in Patients with Cirrhosis Awaiting Liver Transplantation: Results from the Functional Assessment in Liver Transplantation (FrAILT) Study. Hepatology 2016; 63: 574-580
    CrossrefPubMedSearch in Google Scholar
  • 9 Dharancy S, Lemyze M, Boleslawski E. et al. Impact of impaired aerobic capacity on liver transplant candidates. Transplantation 2008; 86: 1077-1083
    CrossrefPubMedSearch in Google Scholar
  • 10 Painter PL, Luetkemeier MJ, Moore GE. et al. Health-related fitness and quality of life in organ transplant recipients. Transplantation 1997; 64: 1795-1800
    CrossrefPubMedSearch in Google Scholar
  • 11 Kondrup J, Müller MJ. Energy and protein requirements of patients with chronic liver disease. J Hepatol 1997; 27: 239-247
    CrossrefPubMedSearch in Google Scholar
  • 12 Hiesmayr MM, Schindler K, Pernicka E. et al. Decreased food intake is a risk factor for mortality in hospitalised patients: The NutritionDay survey 2006. Clin Nutr 2009; 28: 484-491
    CrossrefPubMedSearch in Google Scholar
  • 13 Berzigotti A, Albillos A, Villanueva C. et al. Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: The SportDiet study. Hepatology 2017; 65: 1293-1305
    CrossrefPubMedSearch in Google Scholar
  • 14 Schütz T, Hudjetz H, Roske AE. et al. Weight gain in long-term survivors of kidney or liver transplantation – another paradigm of sarcopenic obesity?. Nutrition 2012; 28: 378-383
    CrossrefPubMedSearch in Google Scholar
  • 15 Aubry E, Aeberhard C, Leuenberger MS. et al. Refeeding-Syndrom: Ein konsensusbasierter Algorithmus für stationäre Patienten. Aktuel Ernahrungsmed 2019; 44: 33-42
    Thieme ConnectPubMedSearch in Google Scholar
  • 16 Sechi G, Serra A. Wernicke's encephalopathy: new clinical settings and recent advances in diagnosis and management. Lancet Neurol 2007; 6: 442-455
    CrossrefPubMedSearch in Google Scholar
  • 17 Plauth M, Schütz T, Buckendahl DP. et al. Weight gain after transjugular intrahepatic portosystemic shunt is associated with improvement in body composition in malnourished patients with cirrhosis and hypermetabolism. J Hepatol 2004; 40: 228-233
    CrossrefPubMedSearch in Google Scholar
  • 18 Tsien C, Shah SN, McCullough AJ. et al. Reversal of sarcopenia predicts survival after a transjugular intrahepatic portosystemic stent. Eur J Gastroenterol Hepatol 2013; 25: 85-93
    CrossrefPubMedSearch in Google Scholar
  • 19 Plank LD, Gane EJ, Peng S. et al. Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: a randomized 12-month trial. Hepatology 2008; 48: 557-566
    CrossrefPubMedSearch in Google Scholar
  • 20 Cabré E, González-Huix F, Abad A. et al. Effect of total enteral nutrition on the short-term outcome of severely malnourished cirrhotics: a randomized controlled trial. Gastroenterology 1990; 98: 715-720
    CrossrefPubMedSearch in Google Scholar
  • 21 Kearns PJ, Young H, Garcia G. et al. Accelerated improvement of alcoholic liver disease with enteral nutrition. Gastroenterology 1992; 102: 200-205
    CrossrefPubMedSearch in Google Scholar
  • 22 Córdoba J, López-Hellín J, Planas M. et al. Normal protein for episodic hepatic encephalopathy: results of a randomized trial. J Hepatol 2004; 41: 38-43
    CrossrefPubMedSearch in Google Scholar
  • 23 Marchesini G, Bianchi G, Merli M. et al. Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial. Gastroenterology 2003; 124: 1792-1801
    CrossrefPubMedSearch in Google Scholar
  • 24 Muto Y, Sato S, Watanabe A. et al. Effects of oral branched chain amino acid granules on event-free survival in patients with liver cirrhosis. Clin Gastroenterol Hepatol 2005; 3: 705-713
    CrossrefPubMedSearch in Google Scholar
  • 25 Elke G, Hartl WH, Kreymann G. et al. DGEM-Leitlinie: Klinische Ernährung in der Intensivmedizin. S2k-Leitlinie (AWMF-Registernummer 073-004). Aktuel Ernahrungsmed 2018; 43: 341-408
    Thieme ConnectPubMedSearch in Google Scholar
  • 26 Olde Damink SWM, Jalan R, Deutz NEP. et al. Isoleucine infusion during “simulated” upper gastrointestinal bleeding improves liver and muscle protein synthesis in cirrhotic patients. Hepatology 2007; 45: 560-568
    CrossrefPubMedSearch in Google Scholar
  • 27 Plank LD, Mathur S, Gane EJ. et al. Perioperative immunonutition in patients undergoing liver transplantation: A randomized souble-blind trial. Hepatology 2015; 61: 639-647
    CrossrefPubMedSearch in Google Scholar
  • 28 Weimann A, Braga M, Carli F. et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr 2017; 36: 623-650
    CrossrefPubMedSearch in Google Scholar