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Redefining Nutritional Requirements in End-Stage Liver Disease: Towards a Personalized Approach

Malnutrition is ubiquitous in cirrhotic patients presenting for liver transplant (LT). Providing an appropriate energy prescription is fundamental to effective nutrition therapy. We aimed to compare measured energy expenditure (mEE) with predicted energy expenditure (pEE) in patients awaiting LT and...

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Autores principales: Chapman, Brooke, Wong, Darren, Whitcher, Bethany, Sinclair, Marie, Gow, Paul, Majumdar, Avik, Testro, Adam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10675823/
https://www.ncbi.nlm.nih.gov/pubmed/38004164
http://dx.doi.org/10.3390/nu15224770
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author Chapman, Brooke
Wong, Darren
Whitcher, Bethany
Sinclair, Marie
Gow, Paul
Majumdar, Avik
Testro, Adam
author_facet Chapman, Brooke
Wong, Darren
Whitcher, Bethany
Sinclair, Marie
Gow, Paul
Majumdar, Avik
Testro, Adam
author_sort Chapman, Brooke
collection PubMed
description Malnutrition is ubiquitous in cirrhotic patients presenting for liver transplant (LT). Providing an appropriate energy prescription is fundamental to effective nutrition therapy. We aimed to compare measured energy expenditure (mEE) with predicted energy expenditure (pEE) in patients awaiting LT and determine clinical factors associated with mEE. In this prospective observational study, energy expenditure was measured by indirect calorimetry in 110 adult patients referred for LT and predicted by commonly utilized equations (Harris–Benedict, Schofield, and EASL guidelines). Nutritional status, anthropometry, muscle function, biochemical and clinical data were also collected. The median model for end-stage liver disease (MELD) was 19 (IQR 13, 25), and the majority were Child–Pugh B (51%) or C (37%). Malnutrition was evident in 85%. Median mEE by calorimetry was 1756 (1531, 2104) kcal/d and significantly higher than pEE as per Harris–Benedict 1480 (1322, 1722) kcal/d and Schofield 1474 (1349, 1723) kcal/d (both p < 0.001), but lower than EASL guidelines (35 kcal/kg) when an activity factor was applied to mEE; 2283 (1990, 2735) kcal/d versus 2590 (2178, 3010) kcal/d (p < 0.001). Hypermetabolism (mEE:pEE > 1.2) was evident in 48% of the cohort. Multivariate analysis found MELD, Child–Pugh class, diuretic use, and severe malnutrition to be independent predictors of hypermetabolism. A new liver-specific predictive model has been developed, showing superior agreement with mEE than common predictive equations. In conclusion, there is a poor correlation between mEE and pEE in patients awaiting LTs, and hypermetabolism is common. Relying on historical predictive equations in this patient population may result in significant under or over-feeding. A tailored energy prescription based on indirect calorimetry or a liver-specific predictive model is recommended for LT candidates.
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spelling pubmed-106758232023-11-13 Redefining Nutritional Requirements in End-Stage Liver Disease: Towards a Personalized Approach Chapman, Brooke Wong, Darren Whitcher, Bethany Sinclair, Marie Gow, Paul Majumdar, Avik Testro, Adam Nutrients Article Malnutrition is ubiquitous in cirrhotic patients presenting for liver transplant (LT). Providing an appropriate energy prescription is fundamental to effective nutrition therapy. We aimed to compare measured energy expenditure (mEE) with predicted energy expenditure (pEE) in patients awaiting LT and determine clinical factors associated with mEE. In this prospective observational study, energy expenditure was measured by indirect calorimetry in 110 adult patients referred for LT and predicted by commonly utilized equations (Harris–Benedict, Schofield, and EASL guidelines). Nutritional status, anthropometry, muscle function, biochemical and clinical data were also collected. The median model for end-stage liver disease (MELD) was 19 (IQR 13, 25), and the majority were Child–Pugh B (51%) or C (37%). Malnutrition was evident in 85%. Median mEE by calorimetry was 1756 (1531, 2104) kcal/d and significantly higher than pEE as per Harris–Benedict 1480 (1322, 1722) kcal/d and Schofield 1474 (1349, 1723) kcal/d (both p < 0.001), but lower than EASL guidelines (35 kcal/kg) when an activity factor was applied to mEE; 2283 (1990, 2735) kcal/d versus 2590 (2178, 3010) kcal/d (p < 0.001). Hypermetabolism (mEE:pEE > 1.2) was evident in 48% of the cohort. Multivariate analysis found MELD, Child–Pugh class, diuretic use, and severe malnutrition to be independent predictors of hypermetabolism. A new liver-specific predictive model has been developed, showing superior agreement with mEE than common predictive equations. In conclusion, there is a poor correlation between mEE and pEE in patients awaiting LTs, and hypermetabolism is common. Relying on historical predictive equations in this patient population may result in significant under or over-feeding. A tailored energy prescription based on indirect calorimetry or a liver-specific predictive model is recommended for LT candidates. MDPI 2023-11-13 /pmc/articles/PMC10675823/ /pubmed/38004164 http://dx.doi.org/10.3390/nu15224770 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Chapman, Brooke
Wong, Darren
Whitcher, Bethany
Sinclair, Marie
Gow, Paul
Majumdar, Avik
Testro, Adam
Redefining Nutritional Requirements in End-Stage Liver Disease: Towards a Personalized Approach
title Redefining Nutritional Requirements in End-Stage Liver Disease: Towards a Personalized Approach
title_full Redefining Nutritional Requirements in End-Stage Liver Disease: Towards a Personalized Approach
title_fullStr Redefining Nutritional Requirements in End-Stage Liver Disease: Towards a Personalized Approach
title_full_unstemmed Redefining Nutritional Requirements in End-Stage Liver Disease: Towards a Personalized Approach
title_short Redefining Nutritional Requirements in End-Stage Liver Disease: Towards a Personalized Approach
title_sort redefining nutritional requirements in end-stage liver disease: towards a personalized approach
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10675823/
https://www.ncbi.nlm.nih.gov/pubmed/38004164
http://dx.doi.org/10.3390/nu15224770
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