title: Negative energy balance secondary to inadequate dietary intake of patients on the waiting list for liver transplantation.
abstract: OBJECTIVE
  The aim of this study was to evaluate the energy balance (EB) of patients on the waiting list for liver transplantation, using total energy expenditure (TEE) assessment and total caloric intake (TCI).
  
  
  METHODS
  We analyzed nutrient adequacy and factors associated with it. EB was obtained by subtracting the TCI (obtained by 3-d food record) from TEE, which was measured as resting energy expenditure and physical activity factor calculation. Socioeconomic and clinical data also were evaluated. Univariate and multiple linear regressions were used (P < 0.05). Seventy-three patients were included.
  
  
  RESULTS
  The TEE was 2318.5 kcal, and the TCI was 1485.1 kcal, with 81.6% of patients presenting with negative EB. There was no significant association between TCI and socioeconomic variables, medications, and encephalopathy (P > 0.05). Women, less-educated patients, those with ascites, and those who were malnourished presented with lower TCI (P < 0.05). Severity of disease, by Child-Pugh and Model for End-Stage Liver Disease scores were associated with EB (P < 0.05). Child-Pugh remained significant after multivariate analyses. Energy inadequacy was observed in 91.8% of patients, and protein inadequacy in 72.6% of patients. Polyunsaturated fatty acid (64.4%) and monounsaturated fatty acid (91.8%) and fiber (94.5%) inadequacies also were high. The percentage of adequate intake was less than 10% for vitamins B5 and D, calcium, folic acid, and potassium, and higher percentages of adequate intake (>80%) were found for iron and vitamins B1 and B12. Moreover, 54.8% and 16.4% of the patients had excessive sodium and cholesterol intakes, respectively.
  
  
  CONCLUSIONS
  Negative EB was highly prevalent among patients on the waiting list for liver transplantation, and was associated with the severity of liver disease. Negative EB was primarily affected by low food intake. The food intake data were characterized by low overall energy and protein intake and inadequate composition of the patient's diet plan, which tended to be characterized by specific nutrient deficiencies and excesses.
authors.affiliation: Surgery Postgraduate Program, Medical School, Universidade Federal de Minas Gerais, MG, Brazil. liviagf@gmail.com
authors.forename: Lívia Garcia
authors.initials: LG
authors.lastname: Ferreira
authors.forename: Aline Isabel
authors.initials: AI
authors.lastname: Ferreira Martins
authors.forename: Carolina Elisa
authors.initials: CE
authors.lastname: Cunha
authors.forename: Lucilene Rezende
authors.initials: LR
authors.lastname: Anastácio
authors.forename: Agnaldo Soares
authors.initials: AS
authors.lastname: Lima
authors.forename: Maria Isabel Toulson Davisson
authors.initials: MI
authors.lastname: Correia
mesh_terms: D000328:Adult; D000368:Aged; D002791:Cholesterol, Dietary / Q000008:administration & dosage; D003430:Cross-Sectional Studies; D015930:Diet Records; D004043:Dietary Fiber; D002149:Energy Intake; D004734:Energy Metabolism; D005229:Fatty Acids, Monounsaturated / Q000008:administration & dosage; D005231:Fatty Acids, Unsaturated / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016014:Linear Models; D016031:Liver Transplantation; D008297:Male; D044342:Malnutrition / Q000503:physiopathology*; D018977:Micronutrients / Q000008:administration & dosage / Q000172:deficiency; D008875:Middle Aged; D009043:Motor Activity; D015596:Nutrition Assessment; D009752:Nutritional Status; D012959:Socioeconomic Factors; D012982:Sodium, Dietary / Q000008:administration & dosage; D014850:Waiting Lists; D055815:Young Adult
chemical_list: D002791:Cholesterol, Dietary; D004043:Dietary Fiber; D005229:Fatty Acids, Monounsaturated; D005231:Fatty Acids, Unsaturated; D018977:Micronutrients; D012982:Sodium, Dietary
keywords: Dietary intake; Energy balance; Liver; Liver transplantation; Transplant