Siroz ve Malnütrisyon

Yıl 2024, , 11 - 24, 30.04.2024

Merve Şatay , Sevan Çetin , İlknur Gökçe Yıldırım

https://doi.org/10.59778/sbfdergisi.1345295

Bu makale için 31 Ağustos 2024 tarihinde bir düzeltme yayımlandı. https://dergipark.org.tr/tr/pub/sbfdergisi/issue/86109/1537082

Öz

Kronik karaciğer hastalığı olarak da adlandırılan siroz, karaciğerde ileri derecede hasar oluşumudur. Çeşitli nedenlere bağlı olarak karaciğerde farklı seviyelerde hasar meydana gelir. Sirozun neden olduğu karaciğer hasarı genellikle geri döndürülemez ancak erken dönemde teşhis edilirse ortaya çıkan hasar sınırlandırılabilir. Siroz, erken dönemde belirti vermese de hastalık derecesi ilerledikçe şiddetli belirtilerle ortaya çıkar. Kronik alkol durumu, Hepatit B ve Hepatit C gibi kronik viral hepatitler sirozun başlıca nedenleridir. Karaciğer hastalıklarında ve sirozda beslenme tedavisinin önemi gün geçtikçe artmaktadır. Malnütrisyon; enerji, protein ve diğer besin ögelerinin yetersiz, dengesiz veya fazla alınması nedeniyle vücut yapı ve fonksiyonlarının ölçülebilir şekilde olumsuz etkilendiği bir durumdur. İstemsiz vücut ağırlığı kaybı malnütrisyonun en iyi göstergelerinden biridir. Karaciğer hastalıklarında çeşitli nedenlere bağlı olarak besin alımı azalmakta ve malnütrisyon oldukça yaygın gözlenmektedir. Malnütrisyon, sirozlu hastalarda etiyolojiden bağımsız olarak gelişmekte ve buna bağlı olarak morbidite ve mortalite yüksekliği de paralellik göstermektedir. Karaciğer hastalarında malnütrisyonu önlemek için tedbirler alınmalı ve saptandığında erken dönemde tedaviye başlanmalıdır. Sirozlu hastalarda beslenme tedavisindeki amaç; çok sıkı diyet kısıtlamalarından kaçınarak malnütrisyonu düzeltmek, enerji ve besin ögesi yetersizliklerini yerine koymaktır. Bu amaçla hastalara oral, enteral ve/veya parenteral yolla beslenme destek tedavileri uygulanmaktadır. Bu derleme siroz ve malnütrisyon arasındaki ilişkinin ve beslenme tedavisinin tartışılması amaçlanmıştır.

Anahtar Kelimeler

Siroz, Malnütrisyon, Beslenme Tedavisi

Cirrhosis And Malnutrition

Bu makale için 31 Ağustos 2024 tarihinde bir düzeltme yayımlandı. https://dergipark.org.tr/tr/pub/sbfdergisi/issue/86109/1537082

Öz

Cirrhosis, also called chronic liver disease, is the formation of an advanced degree of damage to the liver. Depending on various causes, different levels of damage occur in the liver. The cause of cirrhosis of liver damage is usually irreversible, but if it is diagnosed early, the resulting damage can be limited. Although cirrhosis does not cause symptoms at an early stage, it occurs with severe symptoms as the degree of the disease progresses. Chronic alcohol status and chronic viral hepatitis, such as Hepatitis B and Hepatitis C, are the main causes of cirrhosis. The importance of nutritional treatment for liver diseases and cirrhosis is increasing every day. Malnutrition is a condition in which the structure and functions of the body are measurably negatively affected due to insufficient, unbalanced, or excessive intake of energy, protein, and other nutrients. Involuntary loss of body weight is one of the best indicators of malnutrition. In liver diseases, food intake decreases due to various causes, and malnutrition is observed quite widely. Malnutrition develops independently of the etiology in patients with cirrhosis, and accordingly, the morbidity and mortality levels are also parallel. Measures should be taken to prevent malnutrition in liver patients and treatment should be started at an early stage when detected. The purpose of nutrition treatment in cirrhosis patients is to correct malnutrition by avoiding very strict dietary restrictions and to replace energy and nutrient deficiencies. For this purpose, oral, enteral and/or parenteral nutrition support therapies are applied to patients. This review is intended to discuss the relationship between cirrhosis and malnutrition and nutritional treatment.

Anahtar Kelimeler

Cirrhosis, Malnutrition, Nutritional Therapy

Kaynakça

• Amodio, P., Bemeur, C., Butterworth, R., Cordoba, J., Kato, A., Montagnese, S., ... & Morgan, M. Y. (2013). The nutritional management of hepatic encephalopathy in patients with cirrhosis: International Society for Hepatic Encephalopathy and Nitrogen Metabolism Consensus. Hepatology, 58(1), 325-336.
• Aprile, L. R., Meneghelli, U. G., Martinelli, A. L., & Monteiro, C. R. (2002). Gastric motility in patients with presinusoidal portal hypertension. The American journal of gastroenterology, 97(12), 3038–3044. https://doi.org/10.1111/j.1572-0241.2002.07122.x
• Aydın Çil M, Dokuz B, Arslan C. (2017). Karaciğer Sirozu ve Beslenme Tedavisi (Liver Cirrhosis and Nutrition Therapy). Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi. 20(3):225-9.
• Aqel, B. A., Scolapio, J. S., Dickson, R. C., Burton, D. D., & Bouras, E. P. (2005). Contribution of ascites to impaired gastric function and nutritional intake in patients with cirrhosis and ascites. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 3(11), 1095–1100. https://doi.org/10.1016/s1542-3565(05)00531-8
• Bémeur, C., & Butterworth, R. F. (2014). Nutrition in the management of cirrhosis and its neurological complications. Journal of clinical and experimental hepatology, 4(2), 141-150.
• Bischoff, S. C., Bernal, W., Dasarathy, S., Merli, M., Plank, L. D., Schütz, T., & Plauth, M. (2020). ESPEN practical guideline: Clinical nutrition in liver disease. Clinical Nutrition, 39(12), 3533-3562.
• Buran, T, Almacan, B, İnce,F. (2020). Karaciğer Hastalıklarında Malnütrisyon. Güncel Gastroenteroloji Derneği 24/2. 81-85.
• Cederholm, T., Barazzoni, R. O. C. C. O., Austin, P., Ballmer, P., Biolo, G. I. A. N. N. I., Bischoff, S. C., ... & Singer, P. (2017). ESPEN guidelines on definitions and terminology of clinical nutrition. Clinical nutrition, 36(1), 49-64.
• Chapman, B., Sinclair, M., Gow, P. J., & Testro, A. G. (2020). Malnutrition in cirrhosis: More food for thought. World journal of hepatology, 12(11), 883.
• Chen, C. J., Wang, L. C., Kuo, H. T., Fang, Y. C., & Lee, H. F. (2019). Significant effects of late evening snack on liver functions in patients with liver cirrhosis: A meta‐analysis of randomized controlled trials. Journal of gastroenterology and hepatology, 34(7), 1143-1152.
• Cheung, K., Lee, S. S., & Raman, M. (2012). Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies. Clinical Gastroenterology and Hepatology, 10(2), 117-125.
• Córdoba, J., Mínguez, B. ve Vergara, M. (2004). JM Walshe. J Hepatol , 41 , 38-43.
• D'Amico, G., Garcia-Tsao, G., & Pagliaro, L. (2006). Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. Journal of hepatology, 44(1), 217-231.
• Dam, G., Aamann, L., Vistrup, H., & Gluud, L. L. (2018). The role of Branched Chain Amino Acids in the treatment of hepatic Encephalopathy. Journal of clinical and experimental hepatology, 8(4), 448-451.
• Dong, J. L., Liu, Y. Y., Sun, L. Z., He, M. Y., Huang, J. F., & Hu, M. (2016). Effect of late night snack on nutritional status and quality of life in cirrhotic patients. Chinese Journal of Clinical Nutrition, 24(6), 342-348.
• Elsebaie, E. M., Abdel-Fattah, A. N., Bakr, N. A., Attalah, K. M., & Aweas, A. H. A. (2023). Principles of Nutritional Management in Patients with Liver Dysfunction—A Narrative Review. Livers, 3(2), 190-218.
• European Association for the Study of the Liver. (2018). EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. Journal of hepatology, 69(2), 406-460.
• Esin, K., Bingöl, F. N., & Akbulut, G. (2017). Kronik karaciğer hastalıklarında tıbbi beslenme tedavisi. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi.
• Fallahzadeh, M. A., & Rahimi, R. S. (2020). Hepatic encephalopathy and nutrition influences: a narrative review. Nutrition in Clinical Practice, 35(1), 36-48.
• Ferreira, L. G., Santos, L. F., Anastácio, L. R., Lima, A. S., & Correia, M. I. T. (2013). Resting energy expenditure, body composition, and dietary intake: a longitudinal study before and after liver transplantation. Transplantation, 96(6), 579-585.
• George, J., Ganesh, H. K., Acharya, S., Bandgar, T. R., Shivane, V., Karvat, A., ... & Shah, N. (2009). Bone mineral density and disorders of mineral metabolism in chronic liver disease. World Journal of Gastroenterology: WJG, 15(28), 3516.
• Grüngreiff, K., Reinhold, D., & Wedemeyer, H. (2016). The role of zinc in liver cirrhosis. Annals of hepatology, 15(1), 7–16. https://doi.org/10.5604/16652681.1184191
• Gu, X. B., Yang, X. J., Zhu, H. Y., & Xu, B. Y. (2012). Effect of a diet with unrestricted sodium on ascites in patients with hepatic cirrhosis. Gut and liver, 6(3), 355–361. https://doi.org/10.5009/gnl.2012.6.3.355
• Guo, Y. J., Tian, Z. B., Jiang, N., Ding, X. L., Mao, T., & Jing, X. (2018). Effects of late evening snack on cirrhotic patients: a systematic review and meta-analysis. Gastroenterology research and practice, 2018.
• Haberl, J., Zollner, G., Fickert, P., & Stadlbauer, V. (2018). To salt or not to salt?-That is the question in cirrhosis. Liver international : official journal of the International Association for the Study of the Liver, 38(7), 1148–1159. https://doi.org/10.1111/liv.13750
• Holecek, M. (2010). Three targets of branched-chain amino acid supplementation in the treatment of liver disease. Nutrition, 26(5), 482-490.
• Izbeki, F., Kiss, I., Wittmann, T., Varkonyi, T. T., Legrady, P., & Lonovics, J. (2002). Impaired accommodation of proximal stomach in patients with alcoholic liver cirrhosis. Scandinavian journal of gastroenterology, 37(12), 1403-1410.
• Jindal, A., & Jagdish, R. K. (2019). Sarcopenia: Ammonia metabolism and hepatic encephalopathy. Clinical and Molecular Hepatology, 25(3), 270.
• Kachaamy, T., & Bajaj, J. S. (2011). Diet and cognition in chronic liver disease. Current Opinion İn Gastroenterology, 27(2), 174-179.
• Kalal, C., Benjamin, J., Shasthry, V., Kumar, G., Sharma, M. K., Joshi, Y. K., & Sarin, S. K. (2022). Effect of long-term aggressive nutrition therapy on survival in patients with alcohol-related cirrhosis: A randomized controlled trial. Indian Journal of Gastroenterology, 41(1), 52-62.
• Lai, J. C., Dodge, J. L., McCulloch, C. E., Covinsky, K. E., & Singer, J. P. (2020). Frailty and the burden of concurrent and incident disability in patients with cirrhosis: a prospective cohort study. Hepatology communications, 4(1), 126-133.
• Lai, J. C., Tandon, P., Bernal, W., Tapper, E. B., Ekong, U., Dasarathy, S., & Carey, E. J. (2021). Malnutrition, frailty, and sarcopenia in patients with cirrhosis: 2021 practice guidance by the American Association for the Study of Liver Diseases. Hepatology (Baltimore, Md.), 74(3), 1611.
• Madden, A. M., Bradbury, W., & Morgan, M. Y. (1997). Taste perception in cirrhosis: its relationship to circulating micronutrients and food preferences. Hepatology (Baltimore, Md.), 26(1), 40–48. https://doi.org/10.1002/hep.510260106
• Manguso, F., D’ambra, G., Menchise, A., Sollazzo, R., & D’agostino, L. (2005). Effects of an appropriate oral diet on the nutritional status of patients with HCV-related liver cirrhosis: a prospective study. Clinical Nutrition, 24(5), 751-759.
• Marchesini, G., Bianchi, G., Lucidi, P., Villanova, N., Zoli, M., & De Feo, P. (2004). Plasma ghrelin concentrations, food intake, and anorexia in liver failure. The Journal of clinical endocrinology and metabolism, 89(5), 2136–2141. https://doi.org/10.1210/jc.2003-031771
• Marr, K. J., Shaheen, A. A., Lam, L., Stapleton, M., Burak, K., & Raman, M. (2017). Nutritional status and the performance of multiple bedside tools for nutrition assessment among patients waiting for liver transplantation: A Canadian experience. Clinical nutrition ESPEN, 17, 68-74.
• Masuda, T., Shirabe, K., Yoshiya, S., Matono, R., Morita, K., Hashimoto, N., ... & Maehara, Y. (2013). Nutrition support and infections associated with hepatic resection and liver transplantation in patients with chronic liver disease. Journal of Parenteral and Enteral Nutrition, 37(3), 318-326.
• Patel, A., Silverman, S., Baghdadi, J., Shah, O., & Sundaram, V. (2019). Osteoporotic fracture risk and health care burden in patients with cirrhosis. Journal of Clinical Gastroenterology, 53(7), 543-548. Patton, H. M. (2012). Nutritional assessment of patients with chronic liver disease. Gastroenterology & hepatology, 8(10), 687.
• Plauth, M., Bernal, W., Dasarathy, S., Merli, M., Plank, L. D., Schütz, T., & Bischoff, S. C. (2019). ESPEN guideline on clinical nutrition in liver disease. Clinical Nutrition, 38(2), 485-521.
• Ruf, A., Dirchwolf, M., & Freeman, R. B. (2022). From Child-Pugh to MELD score and beyond: Taking a walk down memory lane. Annals of Hepatology, 27(1), 100535.
• Ruiz-Margáin, A., Macías-Rodríguez, R. U., Ríos-Torres, S. L., Román-Calleja, B. M., Méndez-Guerrero, O., Rodríguez-Córdova, P., & Torre, A. (2018). Effect of a high-protein, high-fiber diet plus supplementation with branched-chain amino acids on the nutritional status of patients with cirrhosis. Revista de Gastroenterología de México (English Edition), 83(1), 9-15.
• Runyon, B. A. (2013). Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012. Hepatology, 57(4), 1651-1653.
• Saunders, J., Brian, A., Wright, M., & Stroud, M. (2010). Malnutrition and nutrition support in patients with liver disease. Frontline Gastroenterology, 1(2), 105.
• Sharma, A., & Nagalli, S. (2022). Chronic liver disease. In StatPearls [Internet]. StatPearls Publishing.
• Sharma, P., Gupta, C., Kumar, A., Arora, A., Anikhindi, S. A., Singla, V., ... & Jasrotia, S. (2021). Nutritional assessment and factors affecting dietary intake in patients with cirrhosis: A single-center observational study. Nutrition, 84, 111099.
• Tai, M. L. S., Goh, K. L., Mohd-Taib, S. H., Rampal, S., & Mahadeva, S. (2010). Anthropometric, biochemical and clinical assessment of malnutrition in Malaysian patients with advanced cirrhosis. Nutrition journal, 9(1), 1-7.
• Tandon, P., DenHeyer, V., & Ismond, K. (2018). The Nutrition in Cirrhosis Guide. A Guıde For Patıents. 7-8.
• Taniguchi, E., Kawaguchi, T., Itou, M., Oriishi, T., Ibi, R., Torii, M., ... & Sata, M. (2011). Subjective global assessment is not sufficient to screen patients with defective hepatic metabolism. Nutrition, 27(3), 282-286.
• Tapper, E. B., & Parikh, N. D. (2018). Mortality due to cirrhosis and liver cancer in the United States, 1999-2016: observational study. bmj, 362.
• Traub, J., Reiss, L., Aliwa, B., & Stadlbauer, V. (2021). Malnutrition in patients with liver cirrhosis. Nutrients, 13(2), 540.
• Tsoris, A., & Marlar, C. A. (2019). Use of the Child Pugh score in liver disease.
• Uyanıkoğlu, A. (2020) Siroz. Güncel Gastroenteroloji 24/2. 63-80.
• Yalçın, K., & Ayyıldız, O. (2009). Hemostatic abnormalities in liver cirrhosis. Dicle Tıp Dergisi, 36(2).
• Yamanaka‐Okumura, H., Nakamura, T., Miyake, H., Takeuchi, H., Katayama, T., Morine, Y., ... & Takeda, E. (2010). Effect of long‐term late‐evening snack on health‐related quality of life in cirrhotic patients. Hepatology Research, 40(5), 470-476.
• Yasutake, K., Kohjima, M., Nakashima, M., Kotoh, K., Nakamuta, M., & Enjoji, M. (2012). Nutrition therapy for liver diseases based on the status of nutritional intake. Gastroenterology Research and Practice, 2012.
• Yatsuhashi, H., Ohnishi, Y., Nakayama, S., Iwase, H., Nakamura, T., & Imawari, M. (2011). Anti‐hypoalbuminemic effect of branched‐chain amino acid granules in patients with liver cirrhosis is independent of dietary energy and protein intake. Hepatology Research, 41(11), 1027-1035.
• Yılmaz, O. F. (2021). Oksidatif Stres ve Karaciğer Hastalıkları. Muş Alparslan Üniversitesi Sağlık Bilimleri Dergisi, 1(1), 8-15.
• Yoshiji, H., Nagoshi, S., Akahane, T., Asaoka, Y., Ueno, Y., Ogawa, K., ... & Koike, K. (2021). Evidence-based clinical practice guidelines for liver cirrhosis 2020. Journal of Gastroenterology, 56(7), 593-619.
• Weissenborn, K., Rückert, N., Hecker, H., & Manns, M. P. (1998). The number connection tests A and B: interindividual variability and use for the assessment of early hepatic encephalopathy. Journal of hepatology, 28(4), 646-653.