Influence of liver transplantation in the nutritional profile of severe cirrhotic patients

OBJECTIVE: The aim of this study was to analyze the influence of liver transplantation in food intake and nutritional status of severe cirrhotic patients. METHODS: The sample consisted of 23 patients who underwent liver transplantation. Three 24-hour dietary recall were applied and anthropometric measurements were collected before and three months after transplantation. The consumption of macronutrients and fat soluble vitamins were also evaluated. The anthropometric data evaluated were body mass index, abdominal circumference, percentage of adequacy of arm circumference, triceps skinfold thickness and arm muscle circumference. Related mean comparison tests, comparison of changes in the proportions of categorical variables and correlation of quantitative variables were used in the statistical analysis. Data were considered to be significant when p < 0.05. RESULTS: Most patients were female and aged between 40 and 65 years. The average consumption of calories, proteins, lipids, cholesterol and monounsaturated fatty acids was significantly higher after liver transplantation (p < 0.05). The average of anthropometric parameters did not differ significantly between the evaluated times. There was no significant change in nutrient intake or anthropometric classification after transplantation. Most patients were classified as malnourished or overweight after transplantation, according to some anthropometric parameters. CONCLUSION: Food consumption changed after transplantation. There was no change in the nutritional status from pre- to post-transplant but, in general, most patients had altered nutritional status in both evaluation moments.

Influence of liver transplantation in the nutritional profile of severe cirrhotic patients / La influencia del trasplante de hígado en el perfil nutricional de pacientes cirróticos graves

Objective: The aim of this study was to analyze the influence of liver transplantation in food intake and nutritional status of severe cirrhotic patients. Methods: The sample consisted of 23 patients who underwent liver transplantation. Three 24-hour dietary recall were applied and anthropometric measurements were collected before and three months after transplantation. The consumption of macronutrients and fat soluble vitamins were also evaluated. The anthropometric data evaluated were body mass index, abdominal circumference, percentage of adequacy of arm circumference, triceps skinfold thickness and arm muscle circumference. Related mean comparison tests, comparison of changes in the proportions of categorical variables and correlation of quantitative variables were used in the statistical analysis. Data were considered to be significant when p < 0.05. Results: Most patients were female and aged between 40 and 65 years. The average consumption of calories, proteins, lipids, cholesterol and monounsaturated fatty acids was significantly higher after liver transplantation (p < 0.05). The average of anthropometric parameters did not differ significantly between the evaluated times. There was no significant change in nutrient intake or anthropometric classification after transplantation. Most patients were classified as malnourished or overweight after transplantation, according to some anthropometric parameters. Conclusion: Food consumption changed after transplantation. There was no change in the nutritional status from pre- to post-transplant but, in general, most patients had altered nutritional status in both evaluation moments (AU)

Objetivo: el objetivo de este estudio fue hacer un análisis de las influencias del trasplante de hígado en el consumo alimentario y estado nutricional de pacientes cirróticos graves. Métodos: la muestra fue de 23 pacientes a los que se hizo trasplante de hígado. Se recopilan los datos antropométricos, además de tres recordatorios alimentarios de 24 horas antes y tres meses tras el trasplante. El consumo de macronutrientes y vitaminas liposolubles también fue evaluado. Los datos antropométricos evaluados fueron: índice de masa corporal, circunferencia abdominal, porcentual de adecuación del contorno de cintura, los pliegues cutáneos tricipital y de la circunferencia muscular del brazo. En el análisis estadístico se utilizaron tests de comparación de medias relacionadas, comparación de los cambios en las proporciones de las variables categóricas y la correlación de las variables cuantitativas. Los datos fueron considerados significativos cuando p < 0,05. Resultados: la mayoría de los pacientes estudiados eran del sexo femenino y con edad entre 40 y 65 años. El consumo medio de calorías proteínas, lípidos, colesterol y ácido graso monoinsaturado fue significativamente mayor después del trasplante hepático (p < 0,05). La media de los parámetros antropométricos no difirió significativamente entre los momentos evaluados. No hubo cambio significativo en la ingestión de nutrientes y en la clasificación antropométrica después del trasplante. La mayoría de los pacientes fueron clasificados como desnutridos o con exceso de peso tras el trasplante, de acuerdo con algunos parámetros antropométricos. Conclusión: el consumo alimentario fue modificado después del trasplante. No hubo alteración del estado nutricional del preoperatorio comparado con el postoperatorio, pero de una forma general, la mayoría de los pacientes presentaron alteraciones de su estado nutricional en los dos momentos de la evaluación (AU)

Necator americanus infection: a possible cause of altered dendritic cell differentiation and eosinophil profile in chronically infected individuals.

BACKGROUND: Hookworms survive for several years (5 to 7 years) in the host lumen, inducing a robust but largely ineffective immune response. Among the most striking aspects of the immune response to hookworm (as with many other helminths) is the ablation of parasite-specific T cell proliferative response (hyporesponsiveness). While the role of the adaptive immune response in human helminth infection has been well investigated, the role of the innate immune responses (e.g., dendritic cells and eosinophils) has received less attention and remains to be clearly elucidated. METHODOLOGY/PRINCIPAL FINDINGS: We report on the differentiation/maturation of host dendritic cells in vitro and the eosinophil activation/function associated with human hookworm infection. Mature DCs (mDCs) from Necator americanus (Necator)-infected individuals showed an impaired differentiation process compared to the mDCs of non-infected individuals, as evidenced by the differential expression of CD11c and CD14. These same hookworm-infected individuals also presented significantly down-regulated expression of CD86, CD1a, HLA-ABC, and HLA-DR. The lower expression of co-stimulatory and antigen presentation molecules by hookworm-infected-derived mDCs was further evidenced by their reduced ability to induce cell proliferation. We also showed that this alternative DC differentiation is partially induced by excreted-secreted hookworm products. Conversely, eosinophils from the same individuals showed a highly activated status, with an upregulation of major cell surface markers. Antigen-pulsed eosinophils from N. americanus-infected individuals induced significant cell proliferation of autologous PBMCs, when compared to non-infected individuals. CONCLUSION: Chronic N. americanus infection alters the host's innate immune response, resulting in a possible modulation of the maturation process of DCs, a functional change that may diminish their ability for antigen presentation and thus contribute to the ablation of the parasite-specific T cell proliferative response. Interestingly, a concomitant upregulation of the major cell surface markers of eosinophils was observed in hookworm-infected individuals, indicative of antigen-specific immune responses, especially antigen presentation. We showed that in addition to the postulated role of the eosinophils as effector cells against helminth infection, activated cells may also be recruited to sites of inflammation and contribute to the immune response acting as antigen presenting cells.