Metabolic and Nutritional Repercussions of Liver Disease on Children: How to Minimize Them?

Abstract

Objective: To describe the metabolic and nutritional repercussions of chronic liver disease (CLD), proposing strategies that optimize nutritional therapy in the pre- and post-liver transplantation (LT) period, in order to promote favorable clinical outcomes and adequate growth and development, respectively. Data sources: Bibliographic search in the PubMed, Lilacs and SciELO databases of the last 12 years, in English and Portuguese; target population: children from early childhood to adolescence; keywords in Portuguese and their correlates in English: “Liver Transplant,” “Biliary Atresia,” “Nutrition Therapy,” “Nutritional Status,” and “Child”; in addition to Boolean logics “and” and “or,” and the manual search of articles. Data synthesis: Malnutrition in children with CLD is a very common condition and an important risk factor for morbidity and mortality. There is an increase in energy and protein demand, as well as difficulties in the absorption of carbohydrates, lipids and micronutrients such as fat-soluble vitamins and some minerals. An increase in the supply of energy, carbohydrates and proteins and micronutrients, especially fat-soluble vitamins, iron, zinc and calcium, is suggested, except in cases of hepatic encephalopathy (this restriction is indicated for a short period). Conclusions: Based on metabolic changes and anthropometric and body composition monitoring, a treatment plan should be developed, following the nutritional recommendations available, in order to minimize the negative impact of malnutrition on clinical outcomes during and after LT.

Malnutrition in Biliary Atresia: Assessment, Management, and Outcomes

“…(20) The goal protein amount ranges from 3 to 4 g/kg/day and carbohydrates should make up 40% to 60% of the total energy intake. (20) Protein restriction is not recommended, even if advanced liver disease is present.…”

“…The goal lipid profile should be up to 60% MCTs, with at least 40% long chain triglycerides, so as to prevent EFA deficiencies. (20) The goal protein amount ranges from 3 to 4 g/kg/day and carbohydrates should make up 40% to 60% of the total energy intake. (20) Protein restriction is not recommended, even if advanced liver disease is present.…”

Secondary Malnutrition and Nutritional Intervention in Cholestatic Liver Diseases in Infants

“…Liver transplantation is currently the definitive treatment for most types of liver failure in both children and adults (73)(74)(75)(76). Split grafts, live donations, immunosuppressive regimen upgrades, infectious prophylaxis protocols, and innovative surgical techniques have made it possible to reduce complications and improve survival and quality of life (55)(56)(57)(58)(59)(60)(61)77). However, several nutritional issues become apparent once the most important medical and surgical aspects of transplantation have been controlled and exceeded.…”

“…Post-liver transplantation nutritional issues related to deficits, such as loss of muscle mass, decrease in bone mineral content, and retardation of growth, can be identified even from the clinical pre-transplantation stage. Although there are unknown factors that are involved in these clinical conditions during the intra-and post-transplantation stages, this is likely to be the same condition evolving throughout the natural history of liver disease (22,(77)(78)(79)(80)(81)(82)(83).…”