Nutritional Strategies to Manage Malnutrition and Sarcopenia following Liver Transplantation: A Narrative Review

Abstract

Persisting or newly developed malnutrition and sarcopenia after liver transplant (LT) are correlated with adverse health outcomes. This narrative review aims to examine the literature regarding nutrition strategies to manage malnutrition and sarcopenia after LT. The secondary aims are to provide an overview of the effect of nutrition strategies on the incidence of infections, hospital length of stay (LOS), acute cellular rejection (ACR), and mortality after LT. Four databases were searched. A total of 25 studies, mostly of mid–high quality, were included. Six studies found a beneficial effect on nutritional parameters using branched-chain amino acids (BCAA), immunomodulating diet (IMD), or enteral nutrition (EN) whereas two studies using beta-hydroxy-beta-methylbutyrate (HMB) found a beneficial effect on muscle mass and function. Fourteen studies using pre- or pro-biotics, IMD, and EN were effective in lowering infection and six studies using IMD, BCAA or HMB reported reduced hospital LOS. Finally, four studies using HMB and vitamin D were effective in reducing ACR and one study reported reduced mortality using vitamin D after LT. In conclusion, nutritional intervention after LT has different beneficial effects on malnutrition, sarcopenia, and other advert outcomes. Additional large and well-constructed RCTs using validated tools to assess nutritional status and sarcopenia are warranted to ensure more robust conclusions.

A Qualitative Study on Nutritional Awareness Among Parents of Pediatric Recipients of Liver or Kidney Transplants

“…The extent of parental and familial awareness of nutrition is a factor that directly affects the formulation and implementation of dietary plans for such patients. Following a liver or kidney transplant, patients encounter several challenges, such as the use of immunosuppressants, 10 inadequate nutrition, 11 and heightened stress levels. In such circumstances, it is important that patients and their families are able to maintain the prescribed dietary pattern for optimal physical and mental health.…”

Inflammatory Bowel Disease and Sarcopenia: A Focus on Muscle Strength - Narrative Review

“…Regarding macronutrient deficiencies, protein requirements are increased in both active IBD patients and sarcopenic patients, and intake should be increased to 1.2-1.5 g/kg/d compared to recommendations for general adult population (48,93) . After an inflammatory episode, dietary protein needs in IBD patients may be increased for gastrointestinal mucosal healing, being used as building blocks for macromolecule synthesis in the wounded mucosal area, and for total muscle protein synthesis thus preventing strength decline and sarcopenia (94) .…”

“…In IBD patients, fat malabsorption is also obser-ved because of decreased reabsorption of bile acids that are deconjugated by bacteria in the colon (48) . However, according to the recent European guidelines, dietary supplementation, e.g., n-3 fatty acids, shall not be advised to support the maintenance of remission in patients with IBD (48) , but may be of interest in the case of sarcopenic patients without IBD (93) . Regarding carbohydrates, some authors consider that supplementation with selected fermenting carbohydrates, promoting specific bacteria and/or metabolites, may be beneficial for IBD patients (48) .…”

Nutrition support management of organ transplant recipients in the acute posttransplant phase

“…Studies suggest the advantages of providing EN vs PN include the preservation of gut structure and function, fewer infectious complications, reduced hospital length of stay, and reduced cost. 65,66 Several studies in patients who underwent liver transplantation have shown benefits of early EN (within 48 h of surgery). [67][68][69][70] Hasse et al 67 and Ikegama et al 68 reported reduced infection rates in patients who received early EN via nasointestinal tubes placed during the transplant surgery.…”

“…EN is preferred over parenteral nutrition (PN) in patients following transplantation who have a functional gastrointestinal tract. Studies suggest the advantages of providing EN vs PN include the preservation of gut structure and function, fewer infectious complications, reduced hospital length of stay, and reduced cost 65,66 . Several studies in patients who underwent liver transplantation have shown benefits of early EN (within 48 h of surgery) 67–70 .…”