Nutrition Assessment and Support in Children With End‐Stage Liver Disease

Abstract

Malnutrition is a treatable complication in children with end-stage liver disease (ESLD). Biliary atresia and other cholestatic disorders are the most frequent cause of ESLD in children. No single variable provides adequate information about nutrition status, yet effective nutrition support is the one intervention known to improve pre- and posttransplant outcomes. A proactive approach consisting of screening anthropometry interpreted using appropriate growth references, recognition of clinical manifestations associated with micronutrient deficiency, and timely aggressive nutrition support is of a paramount importance to maximize anabolism and optimize outcomes. This article presents the principles of nutrition assessment, intervention, and monitoring in children with ESLD.

Cirrhosis in children and adolescents: An overview

“…In children and adolescents, the increased energy demands associated with anorexia and nausea may complicate the management of malnutrition [64][65][66] . A comprehensive clinical history and general physical examinations of the child/adolescent must be included in routine clinical practice [67] , and special attention must be paid to changes in muscle mass and body fat depots, both of which reflect important aspects of patient nutritional status.…”

“…Medium-chain triglycerides (MCTs) should account for 30%-50% of lipid intake, as these are absorbed directly by the intestinal epithelium and do not require bile salts for digestion and absorption [65][66][67][68][69][70][71][72] . Although MCT supplementation is crucial for the nutritional management of children with cholestasis, long-chain triglycerides should not be eliminated from the diet, as these substances provide essential fatty acids and contribute to the absorption of lipid-soluble molecules.…”

Manejo de la ascitis secundaria a cirrosis en el paciente pediátrico. Revisión y recomendaciones. Parte 1: Fisiopatología, evaluación diagnóstica, criterios de hospitalización, tratamiento, manejo nutricional

“…[60][61][62][63] Debe evitarse el ayuno o el hipoaporte del PPAC, ya que, por el bajo contenido de glucógeno, rápidamente se produce catabolismo proteico, y aprovecharse al máximo la ventana de suficiencia hepática para que el apoyo nutricional, además, permita su crecimiento. Si bien esto puede generar una ingesta sódica mayor a la recomendada, debe primar el aporte nutricional y administrar diuréticos al aparecer la ascitis.…”

Brain-Derived Neurotrophic Factor in Children and Adolescents with Cirrhosis Due to Biliary Atresia

“…Estimated energy requirement (EER) was used to compare food consumption, considering each subject's age, height and weight following as reference the dietary reference intakes [16] and recommended dietary allowances [17]. Our main criteria to evaluate anorexia was daily food intake below 80% of EER because it reflects a food consumption of less than 66% of the lower limit recommended to children with cirrhosis [18]. To better evaluate nutritional variables, patients were divided into 4 age groups: 0-24, 25-60, 61-120 and older than 120 months.…”