Niedożywienie białkowo-kaloryczne w zaawansowanych stadiach przewlekłych chorób wątroby

*Barbara Rejman-Gruszka¹, Krzysztof Simon²

Summary
Chronic liver diseases predispose to protein-energy malnutrition. The etiology of malnutrition in those illnesses is multifactorial and take into consideration anorexia and digestion disorders, malapsorption and increased energy expenditure. The poor nutritional status causes an aggravated risk of complications and deteriorates prognoses of patients with chronic liver diseases. Therefore early identyfication of undernourished patients becomes very significant for early begining of clinical nutrition, what will prevent or delay appearance of complications, particularly ascites, gastrointestinal varices bleeding or encephalopathy. The assessment of nutritional status is mainly based on Subjective Global Assessment SGA, also contains details from anamnesis and physical examination with anthropometric and clinical measurements. Malnourished patients in end-stage liver diseases reveal increased protein and energy intake, but improvement of their nutritional status depends on proper glycemia regulation, vitamins and micronutrients suplementation. Generally an oral nutritional supplements are recommended. An enteral nutrition is restricted for selected clinical situations and ussually takes a place by the nasogastric tube, while total parenteral nutrition is administered only to maintain appropriate nutritional status of patients after liver transplantation. There is no restrictions in dietary protein intake nowadays. It should be consumed 4-6 smaller and more frequent meals, with nocturnal carbohydrated snack. This article reviews problems of malnutrition in end-stage liver diseases.

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