在末期肝病中重新定义营养需求:朝着个性化的方法
Brooke Chapman1,2,3, Darren Wong2,3, Bethany Whitcher2
1Department of Nutrition and Dietetics, Austin Health, Heidelberg, VIC 3084, Australia.
Nutrients
|November 25, 2023
概括
在肝移植候选人中,营养不良很常见. 测量的能量需求往往超过预测,近一半的人经历过度代谢. 量身定制的能量处方对于这种人群的最佳营养治疗至关重要.
科学领域:
- 临床营养学 临床营养学
- 肝病学 肝病学是一种肝病学.
- 移植医学 移植医学 移植医学
背景情况:
- 营养不良影响了大多数等待肝移植 (LT) 的患者.
- 精确的能量处方对于LT候选人的营养治疗至关重要.
- 现有的预测方程可能不能准确地反映这个群体的能源需求.
研究的目的:
- 为了比较测量的能量消耗 (mEE) 与预测的能量消耗 (pEE) 在等待LT的患者中.
- 确定与mEE相关的临床因素.
- 评估常见预测方程的准确性,并开发肝脏特定模型.
主要方法:
- 对110名成年LT候选人的前性观察研究.
- 使用间接热量计测量能源消耗量.
- 使用哈里斯-本尼迪克特,斯科菲尔德和EASL方程预测的能源支出.
- 收集营养状况,人体测量,肌肉功能和临床数据.
主要成果:
- 平均mEE为1756 kcal/d,明显高于哈里斯-本和斯科菲尔德的预测.
- 48%的患者表现出超高代谢 (mEE:pEE>1.2).
- 根据MELD得分,Child-Pugh等级,利尿剂的使用和严重的营养不良预测了hypermetabolism.
- 一个新的肝脏特异性预测模型显示与mEE更好的一致性.
结论:
- 在LT候选人中,mEE和pEE之间的相关性很差.
- 超高代谢是普遍存在的,标准方程可能会导致不足或过多的养.
- 对于量身定制的能量处方,建议使用间接热量计或肝脏特定模型.
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