The Challenges of Nutritional Assessment in Cirrhosis.
The Challenges of Nutritional Assessment in Cirrhosis.
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DOI：
10.1007/s13668-017-0216-8
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发表时间：
2017-09
影响因子：
4.9
通讯作者：
Medici V
中科院分区：
文献类型：
--
作者：
Molfino A;Johnson S;Medici V
肝硬化患者的营养状况经常与宏量和微量营养素缺乏有关。肝硬化本身是营养不良和营养缺乏的原因，但这些条件必须得到识别和妥善处理，因为它们会恶化肝硬化的预后。本综述的目标是：1）识别和描述与肝硬化营养评估相关的挑战，2）描述在使用临床，实验室和仪器工具评估肝病营养不良患者时的最新进展。最有前途的肝硬化营养评估工具包括生物电阻抗分析获得的相位角的身体成分评估，第三腰椎水平的计算机断层扫描横断图像。皇家免费医院的全球评估算法似乎是有帮助的，但需要进一步验证。肝硬化的营养评估具有挑战性，因为包括水肿在内的几个因素可能会干扰它，并且缺乏经过验证的金标准。无论如何，营养评估方法近年来已经发展起来，并应在临床实践中获得相关性。
Nutritional status in patients with cirrhosis is very frequently associated with macro- and micronutrient deficiencies. Cirrhosis itself is the cause of malnutrition and nutritional deficiencies but these conditions have to be identified and addressed properly as they can worsen the prognosis of cirrhosis. The goals of this review are to 1) identify and describe the challenges associated with nutritional assessment in cirrhosis and 2) describe recent advancements when using clinical, laboratory, and instrumental tools in the evaluation of malnourished patients with liver diseases. The most promising tools for nutritional assessment in cirrhosis include the evaluation of body composition with phase angle obtained by bioelectrical impedance analysis, computed tomography transverse images at the level of third lumbar vertebra. The Royal-Free Hospital global assessment algorithm appears to be helpful but needs further validation. Nutritional assessment in cirrhosis is challenging as several factors, including edema, can interfere with it and because of lack of a validated gold standard. Regardless, nutritional assessment methods have been developed in recent years and should gain relevance in the clinical practice.