Ernährung bei Lebererkrankungen

Zusammenfassung

Ernährungszustand und Leberkrankheit beeinflussen sich gegenseitig. Leberfunktionen werden durch Mangelernährung beeinträchtigt und können durch Ernährungstherapie wieder verbessert werden. Insbesondere chronische Lebererkrankungen führen abhängig von ihrem klinischen Schweregrad zu einer prognostisch relevanten Mangelernährung. Vorhandensein und Ausmaß der Mangelernährung können klinisch ohne technische Verfahren diagnostiziert werden. Bei schweren akuten Lebererkrankungen unterscheiden sich Indikation und Durchführung der Ernährungstherapie nicht wesentlich von denen aus anderer Ursache kritisch Erkrankter. Bei chronischen Leberkrankheiten ist der spontane Verzehr meist ungenügend und häufig besteht ein Eiweißmangel. In abgestuftem Vorgehen sollten Ernährungsberatung, ergänzende orale Trinknahrungen, enterale Sondennahrung und als Zweitlinientherapie die parenterale Ernährung eingesetzt werden. Die Ernährungstherapie mit Sicherstellung einer adäquaten Versorgung an Energie und Eiweiß kann Morbidität und Überleben verbessern.

Abstract

Nutritional status and liver disease influence each other. Liver function is compromized by malnutrition and this impairment can be overcome by nutritional intervention. Depending on disease severity, especially chronic liver disease leads to malnutrition which is an indicator of a poor prognosis. Both presence and degree of malnutrition can be diagnosed clinically without the need for techniqual equipment. In severe acute liver disease, indication and practice of nutritional therapy are not different from those in critically ill patients due to other etiology. In chronic liver disease, spontaneous food intake often is inadequate and frequently there is protein malnutrition. In a stepwise approach individualized dietary counselling, supplemental oral sip feeding, enteral tube feeding or parenteral nutrition as a second line option should be used. Nutritional therapy ensuring adequate provision of energy and protein can improve morbidity and mortality.

Schlüsselwörter

enterale Ernährung - parenterale Ernährung - Eiweißmangel - akutes Leberversagen - Leberzirrhose - Lebertransplantation

Keywords

enteral nutrition - parenteral nutrition - protein malnutrition - acute liver failure - liver cirrhosis - liver transplantation

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