Protein-energy malnutrition in liver cirrhosis
Protein-energy malnutrition in liver cirrhosis
复制标题
肝硬化蛋白质-能量营养不良
DOI：
10.1007/s005350200091
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发表时间：
2002
影响因子：
6.3
通讯作者：
H. Moriwaki
中科院分区：
文献类型：
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作者：
H. Moriwaki
Nakaya Y、Harada N、Kakui S 等。这是在健康受试者饥饿 2 至 3 天后观察到的结果。 6 换句话说，过夜禁食很容易导致肝硬化患者出现类似于饥饿的代谢状态。这一观察结果为可能的临床干预措施提出了一个很好的建议，以减轻肝硬化中如此严重的分解代谢状态。其基本理念很简单——通过晚上补充能量来缩短肝硬化患者夜间禁食的时间。这种补充一般在22：00-23：00左右进行，大约200-250大卡。 7, 8 此类夜间能量补充或深夜小吃可通过减少脂质氧化来改善夜间的燃料代谢，7, 8 最终导致 npRQ 的恢复。 7 在本期《胃肠病学杂志》中，Nakaya 等人。 9 报告了口服富含 BCAA 的营养混合物对肝硬化患者长期禁食后严重分解代谢状态的影响。这项研究通过测量肝硬化患者和对照组 RQ 的昼夜变化以及饥饿对 RQ 的长期影响，提供了非常重要的信息。在 RQ 的日间曲线中，该参数在清晨大幅下降，从而表明夜间禁食对肝硬化代谢状态的影响。参考文献 2 中也报道了这种每日 RQ 分析，但 Nakaya 及其同事 9 RQ 深度下降（表明长期饥饿）的发现是相当新颖的。肝硬化患者 RQ 的急剧下降充分表明这些患者对禁食的敏感性。因此，应尽一切努力减少肝硬化患者的禁食时间，因为正如 Nakaya 及其同事指出的那样，他们在进行胃肠道检查等之前通常必须省略早餐。 9
Nakaya Y, Harada N, Kakui S, et al. that observed in healthy subjects after 2-to 3-day starvation. 6 In other words, an overnight fast readily induces a metabolic state similar to starvation in cirrhotic patients. This observation has prompted a good suggestion for a possible clinical intervention to alleviate such a severe catabolic state in cirrhosis. The underlying idea is very simple—to shorten the fasting period during the night time in cirrhotics by giving energy supplementation in the late evening. This supplementation is usually provided at around 22: 00–23: 00, with approximately 200–250 kcal. 7, 8 Such nocturnal energy supplementation, or late evening snack improves fuel metabolism during the night time by reducing lipid oxidation, 7, 8 finally leading to the recovery of npRQ. 7 In this issue of the Journal of Gastroenterology, Nakaya et al. 9 report the effect of an oral BCAA-enriched nutrient mixture on the severe catabolic state after prolonged fasting in cirrhotic patients. This study provides quite important information by measuring both diurnal changes in RQ and the prolonged effect of starvation on RQ in cirrhotics and controls. In the diurnal curve of RQ there was a deep fall in this parameter in the early morning, thus indicating the impact of nighttime fasting on the metabolic state in cirrhosis. Such diurnal analysis of RQ is also reported in reference 2, but the finding of Nakaya and colleagues9 of the deep fall in RQ, indicating prolonged starvation, is quite novel. The sharper decline of RQ in cirrhotics indicates well the susceptibility of these patients to fasting. Therefore, every effort should be taken to reduce the fasting time in cirhotics, because they must often omit breakfast before, for example, undergoing a gastrointestinal examination, as pointed out by Nakaya and colleagues. 9