TRACE ELEMENTS IN PLASMA AND NUTRITIONAL ASSESSMENT IN PATIENTS WITH COMPENSATED CIRRHOSIS ON A LIVER TRANSPLANT LIST.
BACKGROUND
- In chronic liver disease, trace element levels in plasma are usually low. However, the specific cause and functional implications of this abnormality are yet not well understood. These element levels may decrease as a result of abnormal liver function in patients with cirrhosis and/or malnutrition.


OBJECTIVE
- To evaluate the nutritional status and the profile of trace elements in plasma of patients with cirrhosis on a liver transplant list and to correlate them with disease severity.


METHODS
- This cross-sectional study evaluated 31 male patients diagnosed with compensated liver cirrhosis on a waiting list for liver transplant. Nutritional status was objectively evaluated through anthropometry using Mendenhall score and Blackburn classification, subjectively through the Detsky questionnaire and severity of the disease by MELD and CTP score. Trace elements (Zn, Se, Cu, Ca, Fe, Mg and Mn) in plasma were analyzed by inductively coupled plasma mass spectrometry (ICP-MS). Statistical analysis was performed using Mann-Whitney test.


RESULTS
- According to the nutritional assessment 19 (61.3%) were malnourished and 12 (38.7%) were overweight. Regarding disease severity 12 (39%) were classified as Child A, 17 (55%), Child B and 2 (6%) Child C, with 46.9% of patients with MELD score >17. The trace element analysis indicated that 31 (100%) had Mn levels above the reference range, 23 (74.2%) low levels of Cu, 29 (93.5%) with deficiency of Se, and 31 (100%) low levels of Ca and Mg. Disease severity did not show statistical difference between the studied trace elements, in contrast to the nutritional status, in which the malnourished group showed higher levels of Mn (P=0.01) and Fe (P=0.01) and low levels of Zn (P=0.03) when compared to the overweight group.


CONCLUSIONS
- The results showed that the trace elements in plasma are altered in chronic liver disease; without significant correlation to disease severity, but correlated to nutritional status. Malnutrition is present in the patients studied, nonetheless a new scenario with an increase in the prevalence of overweight was verified regardless of the degree of hepatic decompensation.
Departamento Gastrocentro - Ambulatório de transplante de fígado. Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil., Universidade Estadual de Campinas, Departamento Gastrocentro, Ambulatório de transplante de fígado, Universidade Estadual de Campinas, Campinas SP , Brazil.
Thays Santana
TS
Guerra
Departamento Gastrocentro - Ambulatório de transplante de fígado. Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil., Universidade Estadual de Campinas, Departamento Gastrocentro, Ambulatório de transplante de fígado, Universidade Estadual de Campinas, Campinas SP , Brazil.
Nelci Fenalt
NF
Hoehr
Departamento Gastrocentro - Ambulatório de transplante de fígado. Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil., Universidade Estadual de Campinas, Departamento Gastrocentro, Ambulatório de transplante de fígado, Universidade Estadual de Campinas, Campinas SP , Brazil.
Ilka de Fátima Santana Ferreira
Ide F
Boin
Departamento Gastrocentro - Ambulatório de transplante de fígado. Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil., Universidade Estadual de Campinas, Departamento Gastrocentro, Ambulatório de transplante de fígado, Universidade Estadual de Campinas, Campinas SP , Brazil.
Raquel Silveira Bello
RS
Stucchi
D003430:Cross-Sectional Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications; D016031:Liver Transplantation; D008297:Male; D044342:Malnutrition / Q000097:blood* / Q000209:etiology; D008875:Middle Aged; D015596:Nutrition Assessment; D009752:Nutritional Status; D012720:Severity of Illness Index; D014131:Trace Elements / Q000097:blood*; D014850:Waiting Lists
D014131:Trace Elements