La dieta hiperproteica: su repercusión sobre albúmina sérica, líquido ascítico y estado nutricional en cirrosis / Hyperproteic diet: its impact on serum albumin, ascitic fluid and nutritional status in cirrhosis

Los pacientes con cirrosis hepática por cualquier etiología y muy especialmente alcohólica, presentan malnutrición proteico calórica, lo cual pudiera contribuir a la progresión de la enfermedad. El objetivo de esta investigación fue correlacionar el efecto del consumo de una dieta hiperproteica sobre los niveles de albúmina sérica y los niveles de albúmina del líquido ascítico con la ingesta dietética previa y posterior a la intervención nutricional en pacientes con cirrosis hepática; así como su repercusión sobre el estado nutricional. En este estudio prospectivo, experimental, longitudinal se evaluaron 10 pacientes con diagnóstico de cirrosis hepática, Child Pugh B, (8 hombres y 2 mujeres) (30 - 70 años). Se realizó evaluación antropométrica (IMC), bioquímica sérica y del líquido ascítico e indicadores dietéticos. El análisis se realizó mediante el programa SPSS 15 y Test de Wilcoxon (P=< 0,05). La albúmina sérica al inicio=3,6 + 1,3g/dl y 3,5 + 1,1gr/dl al final y la albúmina del líquido ascítico= 1,4 + 0,7g/dl antes y 2,5 + 0,8 g/dl después. En cuanto al estado nutricional al inicio 7 (70%)= normales, 1 (10 %) = desnutrición grado I y 2 (20%) obesidad. Al final: 6 pacientes (60%)= normales, 2 (20%) obesidad, 1 (10%) sobrepeso y 1 (10%) desnutrición grado I. La dieta hiperproteica contribuyó a aumentar los niveles de proteínas y albúmina del liquido ascítico, e igualmente influyó en el estado nutricional

The patients with cirrhosis for all etiology, have malnutrition and more risk of progression of the disease. The objective of this study was to correlate the effect of hyperproteic diet on levels of serum albumin and albumin levels in the ascitic fluid with dietary intake before and after nutritional intervention in patients with cirrhosis of the liver; as well as their impact on nutritional status. This prospective, experimental and longitudinal study assessed 10 patients with diagnosis of liver cirrhosis Child Pugh B, (8 men and 2 women) (30-70 years). Were practicated an anthropometric evaluation (BMI), serum biochemistry and the ascitic fluid and dietary indicators. The analysis was performed using the program SPSS 15 and Wilcoxon Test (P = < 0,05). Serum albumin at the beginning = 3. 6 + 1.3 g/dl and 3.5 + 1.1gr/dl albumin to the end of the liquid ascitic = 1.4 + 0. 7 g/dl before and 2.5 + 0.8 g/dl then. In terms of nutritional status at the beginning 7 (70%) = normal, 1 (10%) = malnutrition grade I and 2 (20%) obesity. At the end: 6 patients (60%) = normal, 2 (20%) obesity, overweight 1(10%) and 1 (10 per cent) malnutrition grade I. We concluded that hyperproteic diet contributed to increase protein and albumin levels from the ascitic fluid, and also influenced on the nutritional status

[Effects of volatile oil extracts of Anethum graveolens L. and Apium graveolens L. seeds on activity of liver enzymes in rat]

Various products from celery [Apium graveolens] and dill [Anethum graveolens] were used to relieve some of liver dysfunctions in Iranian traditional medicine, yet the potential effects of these two medicinal plants on liver function have not been investigated. To investigate the effects of volatile oil of these plant seeds on some hepatic enzymes including SGPT, SCOT and ALP in rats and also to identify the active components of volatile oils of these plants by GC/MS. Following the preparation of volatile oils, rats were intraperitoneally injected by 500 and 1000 micro l/kg of oils and the enzyme activity was measured at 6, 24, 48, 72, 96, 120, 144 and 168 hr post-injection. GC/MS analysis showed that the D-carvon and D-limonen are the major active components in volatile oil of dill and D-limonen and myrcen of celery. Serum activity of SGPT 24h post-injection of dill essence [500 micro l/kg], celery essence [500 micro l/kg], dill essence [1000 micro1/kg]and celery essence [1000 microl/kg] decreased by 12.85, 11.6, 13.7 and 12.6%, respectively. In the same way, the SGOT activity, under the similar conditions, decreased by 8.7, 10.5, 11.6 and 12.9%, respectively. Activity of SGPT, SGOT and ALP 168 hr post-injection of celery essence at dose of 1000 micro 1/kg, decreased by 21.2, 18.4 and 13.5%, respectively. Injections of dill and celery hydroalcoholic extracts at both doses caused lower enzyme activities. Active ingredients of dill and celery may act as an antioxidant or to decrease the production of free radicals, causing stabilization of hepatocyte membrane and decreasing the release of enzymes into the blood

Consumo dietético de macronutrientes e de micronutrientes e a sua relação com a gravidade da doença hepática / Dietary consumption of macronutrients and micronutrients and their relationship to the severity of hepatic disease

The reduction of the dietary intake in the chronic liver disease can occur as a consequence of the disease treatment or adoption of distorted dietary habits after the diagnosis, which contributes to aggravate the patient ́s nutritional status. The aim of the present work was to characterize the alimentary profile of 147 patients, both male and female, suffering from hepatitis, cirrhosis and hepatocellular carcinoma, through the evaluation of the dietary intake of macronutrients and micronutrients with antioxidant function, represented by vitamins, A, C, and E, besides the intake of minerals, zinc and selenium by patients with chronic liver disease assisted at the University Hospital Clementino Fraga Filho - UFRJ. The food consumption was evaluated through the method of Quantity-Frequency Questionnaire, the dietary intakes of micronutrients were compared to the Recommended Daily Intakes (RDI),and the intakes of macronutrients were compared to the Espenre commendations. The severity of the liver disease was assessed using the Child-Pugh classification (1973). The energy intake decreased along with the disease aggravation. Concerning lipid consumption, an important in adequacy in the consumption of polyunsaturated and mono un saturated fats appears, while the consumption of saturated fat was above the adequate(p<0.05). All the evaluated antioxidant nutrients presented a high percentage of inadequacy. However, no significant differences in the percentages of intake inadequacy according to the different stages of the disease were observed. A significant number of patients informed to have excluded some type of food item from their diets after the diagnosis. We recommend that more attention should be paid to the dietary intake of patients with chronic liver disease in order to improve their life quality and expectancy and prevent the aggravation of their nutritional status, reducing complications and hospitalization costs

La reducción de la ingestión dietética en las hepatopatias crónicas es consecuencia del tratamento de la enfermedad o de la adopción de hábitos alimenticios inadecuados después del diagnóstico y contribuye para el agravamiento del estado nutricional de estos pacientes. En este estudio se caracterizó el perfil alimenticio de 147 pacientes de ambos sexos, portadores de hepatitis, cirrosis o carcinoma hepatocelular (CHC), a través de la evaluación de la ingestión dietética de los macro y micronutrientes. Estos últimos representados por lavitamina A, E y C y los minerales, zinc y selenio de los pacientes portadores de enfermedad hepática crónica atendidos en el Hospital Universitario Clementino Fraga Filho - UFRJ. El consumo alimentar fue evaluado con el método de "Frecuencia d e Consumo Alimentar Semicuantitativo", la ingestión dietética de micronutrientes fue comparada con las recomendaciones de ingestión diaria ­IDR-pregonados por el Institute of Medicine (IOM, 2004) y los macronutrientes con las recomendaciones de la Espen (1997). La gravedad de la enfermedad hepática fue evaluada según la clasificación de Child y Pugh(1973). La ingestión calórica, de acuerdo con lo revelado, se presenta disminuida en correlación conel agravamiento de la enfermedad. Cuánto a la ingestión lipídica, hubo una inadecuación importante en el consumo de grasas poli y monoinsaturados, mientras que el consumo de grasas saturadas revelado estaba arriba del adecuado (p>0,05). Los alimentos antioxidantes evaluados presentan un alto porcentaje de inadecuación, sin embargo, las diferencias en los porcentajes de inadecuación observadas no fueron significativas observadas en relación a la fase de la enfermedad. Un número significativo de pacientes relató haber hecho exclusiones alimenticias después del diagnostico. La ingestión dietética de los pacientes portadores de hepatopatias crónicas necesita mayor atención, objetivando mejorar tanto la calidad como la expectativa de vida, previniendo la deterioración del estado nutricional, reduciendo complicaciones y costos con hopitalización

A diminuição da ingestão dietética nas hepatopatias crônicas ocorre por conseqüência do tratamento da doença ou pela adoção de hábitos alimentares distorcidos após o diagnóstico, contribuindo para o agravo do estado nutricional destes pacientes. O objetivo do trabalho foi caracterizar o perfil alimentar de 147 pacientes, de ambos os sexos, com hepatite, cirrose e carcinoma hepatocelular, através da avaliação da ingestão dietética de macronutrientes e micronutrientes representados pelas vitaminas A, E e C e os minerais, zinco e selênio dos pacientes portadores de doença hepática crônica atendidos no Hospital Universitário Clementino Fraga Filho­ UFRJ. O consumo alimentar foi avaliado através do método de Freqüência de Consumo Alimentar Semi-quantitativo, a ingestão dietética de micronutrientes foi comparada com as recomendações de ingestão diária - IDR preconizados pelo Institute of Medicine (IOM, 2004)e os macronutrientes foram comparados com as recomendações da Espen (1997). A gravidade da doença hepática foi avaliada segundo a classificação de Child e Pugh (1973). A ingestão calórica mostrou-se decrescente de acordo com o agravamento da doença. Quanto ao lipídio consumido, houve uma inadequação importante no consumo de gorduras poli e monoinsaturadas, enquanto, o consumo de gordura saturada mostrou-se acima do adequado (p<0,05). Os nutrientes antioxidantes avaliados apresentaram um elevado percentual de inadequação, porém, não foram observadas diferenças significativas nos percentuais de inadequação de ingestão de acordo com os estágios da doença. Um número significativo de pacientes relatou ter feito exclusões alimentares após o diagnóstico. Recomenda-se uma maior atenção à ingestão dietética dos pacientes portadores de hepatopatias crônicas, objetivando melhorar da qualidade e expectativa de vida, evitando o agravamento de seu estado nutricional, reduzindo complicações e custos com hospitalizações

Fígado e nutrição / Liver and nutrition

A desnutrição calórico-proteica é comum em todas as formas de cirrose e diminui o prognóstico naqueles pacientes na lista de espera ao transplante hepático. O racional na utilização de terapia nutricional naqueles pacientes na lista de espera ao transplante hepático. O racional na utilização de terapia nutricinal nesses pacientes baseia-se na grande melhora, oumesmo na estabilização do quadro metabólico, dando tempo para a regeneração do hepatócito. O autor revisa a terapêutica nutricional na abordagem das doenças hepáticas.

As primarily a metabolic organ, the liver orchestrates a complex away of biochemical process. The regulation of protein and energy metabolism is concentrated in the liver. Consequently the patients with liver disease have abnormal protein calorie malnutrition. The present work makes a revision of as the malnutrition it can alter the prognostic of cirrhotic patients.

Nutrition management in chronic liver disease.

Liver has a central role in nutritional homeostasis and any liver disease leads to abnormalities in nutrient metabolism and subsequent malnutrition. All children with chronic liver disease (CLD) must undergo a periodic nutritional assessment--medical history, anthropometry esp. skinfold thickness and mid-arm circumference, and biochemical estimation of body nutrients. Nutritional rehabilitation is catered to the individual child but generally the caloric intake is increased to 130% of RDA by adding glucose polymers and/or MCT oil (coconut oil) with essential fatty acid supplementation (sunflower oil). The enteral route is preferred and occasionally nasogastric and/or nocturnal feeding are required to ensure an adequate intake. Proteins rich in branched chain amino acids are given in moderation (2-3 gm/kg/day) in compensated cirrhotics unless encephalopathy occurs when protein restriction may be necessary (1 gm/kg/day). Fat-soluble vitamins are supplemented in large quantities esp. in cholestasis along with other vitamins and minerals. Dietary therapy is the mainstay of management of some metabolic liver diseases and may be curative in disorders like galactosemia, fructosemia and glycogen storage disorders. Pre and postoperative nutritional support is an important factor in improving survival after liver transplantation.

Nutrición parenteral total ciclada en niños

El soporte nutricional con nutrición parenteral total (NPT) ha permitido que la sobrevida de muchos niños con disfunción intestinal sea mayor. la gama de disfunción y enfermedad hepática grave relacionada con el uso de la NPT ha emergido como consecuencia del uso de NPT por tiempo prolongado. La colestasis intrahepática, es uno de los problemas más frecuentes y ocacionalmente graves asociados con NPT prolongada. La NPT ciclada (NPT) referida también como intermitente o discontínua, disminuye la incidencia de complicaciones provocadas por NPT prolongada. Muchas ventajas teóricas y prácticas sicológicas por el uso de la NPTC han sido descritas. Este artículo describe las indicaciones, las deferencias maneras de ciclar, la monitori-zación y las complicaciones por la adminis-tración de NPTC en niños.

Nutrición en pacientes con enfermedades hepáticas: (primera parte) / Nutrition in chronic liver diseases

La dieta al poder ser manipulable puede de una u otra forma comprometer la función del hígado o contribuir para mantener la misma a niveles óptimos. El objetivo del presente trabajo fue revisar los recientes avances del efecto de la nutrición sobre los aspectos clínicos en enfermedades hepáticas crónicas y el uso adecuado de medidas dietéticas haciendo énfasis en los estudios que al respecto se han realizado en México. Se incluyeron informes originales en inglés y español a través de información computada (Medline) hasta 1994, además de los informes publicados en revistas nacionales sobre el aspecto nutricio en enfermedades hepáticas

Nutrición en situaciones especiales (Insuficiencia hepática y fistula intestinal) / Nutrition in special situation (Liver failure and intestinal fistula)

Se revisan diferentes causas de enfermedad hepática, sus complicaciones nutricionales, la etiología de la encefalopatia hepática,y se dan sugerencias de como manejar al paciente en insuficiencia hepática desde el punto de vista general y nutricional, haciendo énfasis en el uso de aminoácidos de cadena ramificada. Se discuten los conceptos más importantes, etiología, y principios generales del manejo de las fístulas eterocutáneas