Energy Balance and Nutrition Status: A Prospective Assessment of Patients Undergoing Liver Transplantation

Abstract

Background Energy balance (EB) and its relation to nutrition status throughout the perioperative period of liver transplantation (LTx) patients has been poorly reported in the literature, and this is the primary objective of the current study. Methods A prospective observational study was conducted with patients undergoing LTx, who were assessed before and after the operation. Resting energy expenditure, total energy expenditure (TEE), dietary intake, and EB were evaluated, as well as anthropometry, handgrip strength, and standard phase angle (SPA). The presence of complications after the operation, length of intensive care unit and hospital stay, and death were registered. A P‐value < 0.05 was considered statistically significant. Results The average age was 54.1 ± 11.5 years; 79.3% of the patients were male, and the mean model for end‐stage liver disease (MELD) score was 16.7 ± 4.6. Negative EB was seen in 71.4% and 77.8% of patients before and after LTx, respectively. Food intake further decreased after the operation, leading to a significantly more negative EB. The prevalence of malnutrition ranged from 17.2% to 57.7% pretransplantation and 30.8% to 86.4% postoperatively, according to the different methods used. Increased preoperative TEE (0.040) and age (0.039) were predictive factors for complications, and low SPA was a predictive factor of death (0.038). Conclusion Negative EB was prevalent, and this was associated with high rates of malnutrition. These data reinforce the importance of individual nutrition assessment, including dietary intake, to tailor early nutrition interventions.

Energy expenditure early after liver transplantation: Better measured than predicted

“…Energy supply needs to be balanced towards the patients total energy expenditure (TEE), which includes REE, food-related thermogenesis and energy expenditure related to physical activity (39). A recent study of energy balance demonstrated that 77.8% of measured energy requirement was met between the 7th and 10th day after liver transplantation (183), however only 6.9% had enteral nutrition to support the energy intake. There has been a lot of debate on whether to provide a hypocaloric or isocaloric feed in ICU-patients (184).…”

Energy Expenditure and Liver Transplantation: What We Know and Where We Are

“…Several authors have performed longitudinal follow‐up assessments of mREE in LTx patients , 8,9,24–26,50,53 for ≤50 months postsurgery (Table 3).…”

“…Studies with shorter follow‐up periods post‐LTx also revealed no changes in the mREE after surgery 50,53 . A survey of 25 liver recipients reported the mREE of patients, measured ≤72 hours post‐LTx (baseline) and at 5, 10, and 15 days postsurgery.…”

“…62 It is important to highlight that this review encompasses studies conducted at different times, and thus variability in the types of calorimeters used to determine the mREE cannot be ruled out. However, majority of the studies were performed using the Deltatrac calorimeter 35,37,39,9,40,46,24,26,27,49 and the COSMED, 6,28,50,53,52 which have previously been validated for accuracy. 63,64 Furthermore, in longitudinal studies, all the assessments were conducted using the same device.…”

“…Studies with shorter follow-up periods post-LTx also revealed no changes in the mREE after surgery. 50,53 A survey of 25 liver recipients reported the mREE of patients, measured ≤72 hours post-LTx (baseline) and at 5, 10, and 15 days postsurgery. The mean baseline mREE was 1832.0 ± 952.0 kcal/d, decreasing to 1565.0 ± 383.0 kcal/d on the 5th day and 1578.0 ± 418.0 kcal/d on the 15th day, with no significant differences.…”