Büşra DOKUZ, Cansu ARSLAN, Mevra ÇİL AYDIN

KARACİĞER SİROZU VE BESLENME TEDAVİSİ

Dünyada ve Türkiye'de karaciğer sirozu prevelansı artmaktadır. Bu hastalığın ilerlemesinde ve şiddetindeki öneme rağmen beslenme odak noktası olmamıştır. Malnutrisyon bu hastalarda sık görülür ve birçok araştırmada, siroz hastalarında beslenme yetersizlikleri ile artan komplikasyon ve mortalite arasında ilişki olduğu ortaya konulmuştur. Bu nedenle erken dönemde siroz hastalarında beslenme durumu değerlendirilmesi ve diyet modifikasyonları önemlidir. Öncelikle hastanın beslenme durumu değerlendirilmeli, beslenme öyküsü ve besin tüketimleri alınmalıdır. Hastanın antropometrik ölçümleri değerlendirilirken ödem durumu dikkate alınmalıdır. Sirozlu hastaların enerji ve protein gereksinimleri sağlıklı bireylere göre artmıştır. Kişiye özgü yeterli enerji ve protein içeren diyetler planlanmalı ve hastanın tüketimleri takip edilmelidir. Özellikle yağda eriyen vitaminler, tiamin, folat, çinko düzeyleri değerlendirilmeli eğer vitamin-mineral yetersizlikleri varsa hastaya suplemente edilmelidir. Öğün planı yapılırken gece açlıklarını önlemek için mutlaka gece ara öğününe yer verilmeli ve dallı zincirli aminoasit suplementasyonları özellikleri bu öğünde kullanılmalıdır. Hepatik enselafopati gelişmiş hastada protein kısıtlaması yapılıyorsa bu uzun sürmemeli ve dallı zincirli aminoasitlerle desteklenmelidir. Protein kaynağı olarak bitkisel besinler ve süt ürünleri tercih edilmelidir. Planlanan beslenme programıı, hastada konstipasyon gelişimini önlemek ve ensefalopati riskini azaltmak için yeterli posa (25-40 g) içermelidir. Ascit ve ödem varlığında sodyum alımı (< 2g), hiponatremi varlığında sıvı alımı kısıtlanmalıdır. Hastanın oral alımları yetersiz ise enteral veya parenteral destek yapılmalıdır.

Liver cirrhosis and nutrition therapy

Liver cirrhosis and nutrition therapy Prevelance of liver cirrhosis is increasing in the world and Turkey. Despite the importance of the progress and severity of this disease nutrition has not been the focus. Malnutrition is common in these patients and increases the severity of the disease. in many research has been demonstrated that there is a relationship between increasing complication and mortality with nutritional deficiencies. Therefore evaluation of nutritional status and dietary modifications is important in the early stage. First, the patient's nutritional status should be evaluated, nutritional habits and food consumption should be taken. While assessing the patient 's anthropometric measurements, the state of edema should be considered. Cirrhotic patient's energy and protein requirements have increased compared to healthy individuals. İndividual diet has to include sufficient energy and protein consumption. Especially fat -soluble vitamins , thiamine , folate, zinc levels should be monitored if there is its deficiencies, should be supplemented. Meal plan include night snacks to prevent night hunger and branched chain aminoacides use in this meal. If protein restriction is done, it should not take long and should be supported by branched chain aminoacides in patients with hepatic encephalopathy. As a source of protein plant foods and dairy products should be preferred.. The diet plan that prevent the development of constipation in patients and reduce the risk of hepatic encephalopathy must contain sufficient fiber ( 25-40 g). sodium intake in the presence of ascites and edema (< 2g) , hyponatremia presence of fluid intake should be restricted purchases. If oral intake is insufficient should be given to patient enteral or parenteral support.

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Amodio P, Bemeur C, Butterworth R, Cordoba J, Kato A, Montagnese S et al. The nutritional management of hepatic encephalopathy in patients with cirrhosis: International Society for Hepatic Encephalopathy and Nitrogen Metabolism Consensus. Hepatology 2013; 8(1):325-36.
Bémeur C, Butterworth R F. Reprint of: Nutrition in the Management of Cirrhosis and its Neurological Complications. Journal of Clinical and Experimental Hepatology 2015; 5:131-40.
Cabre E, Gassull MA. Nutrition in liver disease. Current Opinion in Clinical Nutrition & Metabolic Care 2005; 8(5):545-51.
Cheung K, Lee S S, Raman M. Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies. Clinical Gastroenterology and Hepatology 2012; 10(2): 117-25.
Dam G, Ott P, Aagaard NK, Gluud LL, Vilstrup H. Branched Chain Amino Acids and Blood Ammonia. In: Rajendram R, Preedy VR, Patel VB eds. Branched Chain Amino Acids and Blood Ammonia. In Branched Chain Amino Acids in Clinical Nutrition. 1 st ed., New York: Humana Press; 2015: p. 101-12.
da Silveira, T. R. Comparison between handgrip strength, subjective global assessment, and prognostic nutritional index in assessing malnutrition and predicting clinical outcome in cirrhotic outpatients. Nutrition 2005; 21(2):113-7.
Duffin, J M. Why does cirrhosis belong to Laennec? Canadian Medical Association Journal 1987; 137(5):393.
Fialla AD, Israelsen M, Hamberg O, Krag A, Gluud LL. Nutritional therapy in cirrhosis or alcoholic hepatitis: a systematic review and meta- analysis. Liver International 2015; 35(9): 2072-8.
Fukushima H, Miwa Y, Ida E, Kuriyama S, Toda K, Shimomura Y et al. Nocturnal branched-chain amino acid administration improves protein metabolism in patients with liver cirrhosis: comparison with aytime administration. JPEN 2003; 27:315-22.
Gluud L. L., Dam G, Les I, Córdoba J, Marchesini G, Borre M et al. Branched- chain amino acids for people with hepatic encephalopathy. The Cochrane Library, 2015.
Holecek M. Three targets of branched-chain amino acid supplementation in the treatment of liver disease. Nutrition 2010; 26(5):482-90.
Iwasa M, Iwata K., Hara N., Hattori A., Ishidome M., Sekoguchi-Fujikawa N et al. Nutrition therapy using a multidisciplinary team improves survival rates in patients with liver cirrhosis. Nutrition 2013;29(11):1418-21.
Johnson TM , Overgard EB, Cohen AE, DiBaise JK. Nutrition Assessment and Management in Advanced Liver Disease. Nutrition in Clinical Practice 2013; 28:15-29.
Lunia MK, Sharma BC, Sharma P, Sachdeva S, Srivastava S. Probiotics prevent hepatic encephalopathy in patients with cirrhosis: a randomized controlled trial. Clinical Gastroenterology and Hepatology 2014; 12(6):1003-8.
Moctezuma-Velázquez C, García-Juárez I, SotoSolís R, Hernández-Cortés J, Torre A. Nutritional assessment and treatment of patients with liver cirrhosis. Nutrition 2013; 29(11):1279-85.
Mokdad AA, Lopez AD, Shahraz S, Lozano R, Mokdad AH, Stanaway J, et al. Liver cirrhosis mortality in 187 countries between 1980 and 2010: a systematic analysis. BMC medicine 2014; 12(1):145.
Muto Y, Sato S, Watanabe A, Moriwaki H, Suzuki K, Kato A, et al. Effects of oral branched-chain amino acid granules on event-free survival in patients with liver cirrhosis. Clinical Gastroenterology and Hepatology 2005; 3(7):705-13.
Nakaya Y, Okita K, Suzuki K, Moriwaki H, Kato A, Miwa Y, et al. BCAA-enriched snack improves nutritional state of cirrhosis. Nutrition 2007; 23:113- 20.
Ney M, Abraldes JG, Ma M, Belland D, Harvey A, Robbins S, et al. Insufficient Protein Intake Is Associated With Increased Mortality in 630 Patients With Cirrhosis Awaiting Liver Transplantation. Nutrition in Clinical Practice 2015,0884533614567716.
Norman K, Kirchner H, Lochs H, Pirlich M. Malnutrition affects quality of life in gastroenterology patients. World Journal of Gastroenterology 2006; 12(21):3380.
Norman K, Pirlich M. Malnutrition in Liver Cirrhosis: Effects of Nutritional Therapy. Preedy, V. R., Lakshman, R. Srirajaskanthan, R. Watson, R.R eds. Nutrition, Diet Therapy, and the Liver. CRC pres; 2009: p. 217-29.
Sarin SK, Dhingra N, Bansal A, Malhotra S, Guptan RC. Dietary and nutritional abnormalities in alcoholic liver disease: a comparison with chronic alcoholics without liver disease. American Journal of Gastroenterology 1997; 92:777-83.
Sengupta S, Wroblewski K, Aronsohn A, Reau N, Reddy KG, Jensen D et al. Screening for Zinc Deficiency in Patients with Cirrhosis: When Should We Start? Digestive diseases and sciences 2015; 1-6.
Suzuki K, Takikawa Y. Biomarkers of Malnutrition in Liver Cirrhosis. Nutrition, Diet Therapy, and the Liver. Preedy VR, Lakshman R, Srirajaskanthan R, Watson RR eds. Nutrition, Diet Therapy, and the Liver. CRC press; 2009: p. 203-16.
Xu J, Ma R, Chen LF, Zhao LJ, Chen K, Zhang RB. Effects of probiotic therapy on hepatic encephalopathy in patients with liver cirrhosis: an updated meta-analysis of six randomized controlled trials. Hepatobiliary & Pancreatic Diseases International 2014; 13(4): 354-60
Yasutake K, Kohjima M, Nakashima M, Kotoh K, Nakamuta M, Enjoji M. Nutrition Therapy for Liver Diseases Based on the Status of Nutritional Intake. Gastroenterology Research and Practice 2012; https://dx.doi.org/10.1155%2F2012%2F859697