Gamze AKBULUT, Fatma Nur BİNGÖL, Kübra ESİN

KRONİK KARACİĞER HASTALIKLARINDA TIBBİ BESLENME TEDAVİSİ

Kronik karaciğer hastalarında malnütrisyon yaygın görülen bir komplikasyondur. Hastalığın ilerlemesi ile birlikte malnütrisyon oranı artmaktadır. Malnütrisyon temel olarak yetersiz ve/veya kalitesiz besin alımı, sindirim ve emilim bozukluğu, dinlenme enerji harcamasının ve besin öğesi gereksinmesinin artması sonucu görülmektedir. Malnütrisyonun neden olabileceği komplikasyonları önlemek için kronik karaciğer hastalarında malnütrisyon ve beslenme durumu değerlendirmesi yapılmalıdır. Hastaların malnütrisyonunun tanımlanmasında ve beslenme durumunun değerlendirilmesinde genellikle Subjektif Global Değerlendirme (SGA) yöntemi ve antropometrik ölçümler (üst orta kol çevresi, el kavrama gücü, biyolelektrik impedans yöntemi) kullanılmaktadır. Kronik karaciğer hastalarında malnütrisyonu önlemek ve besin öğesi gereksinmelerini karşılamak amaçlı oral, enteral ve/veya parenteral yolla beslenme destek tedavileri uygulanmaktadır. Beslenme tedavisi uygulanırken, hepatik ensefalopatinin ilerlemiş evreleri hariç, enerji ve protein kısıtlaması yapılmamalıdır. Yine bu hastalarda az ve sık beslenmeye, düzenli gece öğünü tüketimine dikkat edilmelidir. Kronik karaciğer hastalarında dallı zincirli aminoasitlerin kullanımı hastalığın seyrini olumlu etkilemektedir. Alkolik hepatitte N-asetil sisteinin; hepatik ensefalopatide ise probiyotik ve L ornitin-aspartatın beslenme tedavisinde alternatif olarak kullanımının olumlu sonuçlarına ilişkin çalışmalar mevcut olup, konu ile ilgili yeni çalışmalara gereksinim duyulmaktadır. Sonuç olarak, yeterli ve uygun tıbbi beslenme tedavisi ile hastaların klinik ve metabolik bulguları iyileşmekte, yaşam kaliteleri artmakta ve sağ kalım süreleri uzamaktadır. Bu derleme çalışmada, güncel literatür taramaları doğrultusunda kronik karaciğer hastalarının tıbbi beslenme tedavisi üzerinde durulmuştur.

Anahtar Kelimeler:

Kronik Karaciğer Hastalıkları, Beslenme, Malnütrisyon

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