title: Enteral energy and macronutrients in end-stage liver disease.
abstract: Protein-energy malnutrition is the most common comorbidity affecting adults and children with end-stage liver disease. Despite clear evidence linking malnutrition to poor outcomes before and after liver transplantation, nutrition rehabilitation is often inadequately emphasized in the clinical management of these patients. The primary aim of this review is to synthesize the available evidence supporting the current clinical guidelines on enteral nutrition support and, more important, to highlight the lack of evidence behind much of what is considered "standard of care" for the nutrition management of patients with cirrhosis. In addition, the mechanisms of malnutrition are reviewed, the limitations of tools used to assess body composition in this setting are discussed, and the differences in macronutrient metabolism between healthy subjects and patients with end-stage liver disease are explained. A summary of recommendations is provided.
authors: Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto Department of Paediatrics, University of Toronto, Toronto marialena.mouzaki@sickkids.ca.
authors: Marialena
authors: M
authors: Mouzaki
authors: Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto Department of Paediatrics, University of Toronto, Toronto.
authors: Vicky
authors: V
authors: Ng
authors: Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto Department of Paediatrics, University of Toronto, Toronto.
authors: Binita M
authors: BM
authors: Kamath
authors: Division of Medicine, University Health Network, Toronto.
authors: Nazia
authors: N
authors: Selzner
authors: Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto Department of Paediatrics, University of Toronto, Toronto.
authors: Paul
authors: P
authors: Pencharz
authors: Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto Department of Paediatrics, University of Toronto, Toronto.
authors: Simon C
authors: SC
authors: Ling
mesh_terms: D001823:Body Composition; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D004044:Dietary Proteins / Q000008:administration & dosage; D058625:End Stage Liver Disease / Q000628:therapy*; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D006801:Humans; D008103:Liver Cirrhosis / Q000628:therapy*; D016031:Liver Transplantation; D015596:Nutrition Assessment; D009752:Nutritional Status; D011502:Protein-Energy Malnutrition / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004044:Dietary Proteins
keywords: body composition; cirrhosis; metabolism; nutrition