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

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          Abstract

          Abstract 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.

          Translated abstract

          Resumen 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.

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          Most cited references34

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          Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, and Carotenoids

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            Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value.

            As detected by cross-sectional imaging, severe muscle depletion, which is termed sarcopenia, holds promise for prognostication in patients with cirrhosis. Our aims were to describe the prevalence and predictors of sarcopenia in patients with cirrhosis listed for liver transplantation (LT) and to determine its independent prognostic significance for the prediction of waiting-list mortality. Adults listed for LT who underwent abdominal computed tomography/magnetic resonance imaging within 6 weeks of activation were retrospectively identified. The exclusions were hepatocellular carcinoma, acute liver failure, prior LT, and listing for multivisceral transplantation or living related LT. Sixty percent of the 142 eligible patients were male, the median age was 53 years, and the median Model for End-Stage Liver Disease (MELD) score at listing was 15. Forty-one percent were sarcopenic; sarcopenia was more prevalent in males versus females (54% versus 21%, P < 0.001) and increased with the Child-Pugh class (10% for class A, 34% for class B, and 54% for class C, P = 0.007). Male sex, the dry-weight body mass index (BMI), and Child-Pugh class C cirrhosis (but not the MELD score) were independent predictors of sarcopenia. Sarcopenia was an independent predictor of mortality (hazard ratio = 2.36, 95% confidence interval = 1.23-4.53) after adjustments for age and MELD scores. In conclusion, sarcopenia is associated with increased waiting-list mortality and is poorly predicted by subjective nutritional assessment tools such as BMI and subjective global assessment. If this is validated in larger studies, the objective assessment of sarcopenia holds promise for prognostication in this patient population. Copyright © 2012 American Association for the Study of Liver Diseases.
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              Mudanças na composição e adequação nutricional da dieta familiar nas áreas metropolitanas do Brasil (1988-1996)

              OBJETIVO: Atualizar a tendência secular (1962-1988) da composição e da adequação nutricional da dieta familiar praticada nas áreas metropolitanas do Brasil, com base em nova pesquisa sobre orçamentos familiares realizada em meados da década de 90. MÉTODOS: Utilizaram-se como fontes de dados as pesquisas sobre orçamentos familiares (POF) da Fundação IBGE, realizadas entre março de 1987 e fevereiro de 1988 (13.611 domicílios) e entre outubro de 1995 e setembro de 1996 (16.014 domicílios), tendo ambas como universo de estudo as áreas metropolitanas do Brasil. Nas duas pesquisas chegou-se à disponibilidade domiciliar diária per capita de alimentos, dividindo-se o total de alimentos adquiridos no mês pelo número de pessoas residentes no domicílio e pelo número de dias do mês. O padrão alimentar foi caracterizado com base na participação relativa de grupos selecionados de alimentos e de nutrientes na disponibilidade calórica total. A comparação entre as duas pesquisas levou em conta o conjunto das áreas metropolitanas do País e estratos dessas áreas correspondentes às regiões menos desenvolvidas (Norte e Nordeste) e mais desenvolvidas (Centro-Oeste, Sudeste e Sul). RESULTADOS: Observou-se intensificação do consumo relativo de carnes, de leites e de seus derivados (exceto manteiga) em todas as áreas metropolitanas, enquanto o consumo de ovos passou a declinar, sobretudo no Centro-Sul do País. Leguminosas, raízes e tubérculos prosseguiram sua trajetória descendente, mas cereais e derivados tenderam a se estabilizar no Centro-Sul ou mesmo a se elevar ligeiramente no Norte-Nordeste. A participação relativa de açúcar refinado e refrigerantes cresceu em todas as áreas, sendo que a participação de óleos e gorduras vegetais manteve-se constante no Norte-Nordeste e declinou intensamente no Centro-Sul. CONCLUSÕES: A tendência ascendente da participação relativa de lipídios na dieta do Norte e do Nordeste, o aumento no consumo de ácidos graxos saturados em todas as áreas metropolitanas do País, ao lado da redução do consumo de carboidratos completos, da estagnação ou da redução do consumo de leguminosas, verduras, legumes e frutas e do aumento no consumo já excessivo de açúcar são os traços marcantes e negativos da evolução do padrão alimentar entre 1988 e 1996. Mudanças que podem indicar a adesão da população a dietas mais saudáveis -- declínio no consumo de ovos e recuo discreto da elevada proporção de calorias lipídicas -- foram registradas apenas no Centro-Sul do País.
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                Author and article information

                Journal
                nh
                Nutrición Hospitalaria
                Nutr. Hosp.
                Grupo Arán (Madrid, Madrid, Spain )
                0212-1611
                1699-5198
                February 2018
                : 35
                : 1
                : 104-109
                Affiliations
                [1] Fortaleza Ceará orgnameUniversidade Estadual do Ceará Brazil
                Article
                S0212-16112018000100104 S0212-1611(18)03500100104
                10.20960/nh.1113
                19ab0932-3cc2-40b5-8b9b-c0ff493da8ee

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 14 March 2017
                : 10 August 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 34, Pages: 6
                Product

                SciELO Spain

                Categories
                Original Papers

                Liver cirrhosis. Nutritional status,Consumo alimentario,Trasplante de hígado,Cirrosis hepática,Estado nutricional,Food consumption,Liver transplantation

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