《2006ESPEN肠内营养指南：肝脏疾病》内容预览

Preliminary remarks: There are no randomised controlled trials available on nutritional therapy in non-alcoholic steatohepatitis (NASH). Unlike alco-holic steatohepatitis (ASH), NASH often is asso-ciated with overnutrition and insulin resistance. Therefore recommendations given for ASH cannot easily be applied to NASH despite remarkable similarities. Nutritional recommendations for NASH patients focus on the underlying disease (metabolic syndrome, other secondary causes).
1.1. Does nutritional status influence outcome in ASH? Which is the best widely applicable method to assess nutritional status?
The prognostic value of nutritional status in patients with alcoholic hepatitis has been demonstrated (III). Simple bedside methods such as the Subjective Global Assessment (SGA) or anthropometry are considered adequate for identifying patients at risk (C).
Comment: Several publications from the American Veteran Affairs (VA) study report a higher rate of complications and mortality in undernourished ASH patients.In order to identify undernutrition, a scoring system consisting of variables such as actual/ideal weight, anthropometry, creatinine index, visceral proteins, absolute lymphocyte count, delayed type skin reaction was used in these studies. This composite scoring system includes unreliable variables such as plasma concentrations of visceral proteins or 24-h urine creatinine excre-tion and has been modified repeatedly, the most recent publication of the series also reported a prognostic significance of the variables absolute CD8+count and hand g** strength.
Moreover, a clear association between low intake of normal food and high mortality was found.

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