| Objectives1. To assess nutritional status of patients with liver cirrhosis in different group-Child-pugh A, B and C by anthropometry, body composition analysis, metabolic rate measurement, biochemical tests, laboratory tests to provide evidence for reasonable hospital treatment.2. To analysis and specify the change of the human body composition in patients with cirrhosis before and after the nutritional.Methods1. Analysis of nutritional status in cirrhosis patients.116cirrhotic patients,who were met the diagnostic criteria proposed of the "Symposium on Viral Hepatitis and Liver Diseases in2000" in department of Gastroenterology from2010.8to2013.9,(69males and37females) were selected. The mean age was (61.7±11.9) year old. The cirrhotic patients were divided into group A, B and C based on Child-pugh. The mid arm circumference, arm muscle circumference, triceps skinfold thickness and grip strength were measured. The body composition of patients was measured by multi-frequency bioelectrical impedance analysis. The resting energy expenditure of each group was tested by indirectly energy measurement system, also including albumin, hemoglobin, total lymphocyte count. Rapid reactive proteins were measured to comprehensively evaluate the nutritional status of patients and the relationship between grip strength and body composition analysis indicators, blood indicators was researched.2. The impact of nutrition intervention on body composition in cirrhosis patients32cirrhotic patients in department of Gastroenterology from2013.8to2013.12,(18males and13females) were selected. All patients were complicated with bleeding esophageal varices underwent endoscopic hemostasis and NRS-2002score were≥3and accepted nutrition intervention. During the treatment the patients get0-1091kcal by meal, and121-363kcal by oral nutritional supplements (ONS). The ONS was taking on9:00,15:00and20:00. Body composition was analyzed before and after the nutrition intervention. Results1. Analysis and Research of nutritional status in cirrhosis patients.1.1Anthropometry: mid arm circumference, arm muscle circumference, triceps skinfold thickness and grip strengthThe mid arm circumference showed no significant difference between3groups (P>0.05); the mid arm circumference in male decreased with child-pugh increasing and individuals in group A was significantly higher than C individuals(P<0.05), while there shows no significantly difference in female individuals(P>0.05).The arm muscle circumference decreased with child-pugh increasing and individuals in group A and was significantly higher than C individuals(P<0.05); The arm muscle circumference in male decreased with child-pugh increasing and individuals in group A and was significantly higher than C individuals(P<0.05) while there shows no significance in female individuals(P>0.05).Patients in group B have a higher triceps skinfold thickness than that in C patients(P<0.05); Patients in group B have a higher triceps skinfold thickness than that in C patients(P<0.05); The triceps skinfold thickness in fameles decreased with child-pugh increasing and individuals in group A and was significantly higher than C individuals(P<0.05);The grip strength showed no significant difference between3groups (P>0.05); the grip strength in male decreased with child-pugh increasing and patients in group A was significantly higher than C individuals(P<0.05), while there shows no significantly difference in female individuals(P>0.05).1.2Analysis of body composition:intracellular water, extracellular water, total body water, ECW/TBW, protein, fat, skeletal muscle mass, body mass indexThe intracellular water, total body water, protein, body mass index showed no significant difference between3groups (P>0.05); in male decreased with child-pugh increasing and patients in group C was significantly lower than A and B individuals(P<0.05), while there shows no significantly difference in female individuals(P>0.05).The ECW/TBW increased with child-pugh increasing and patients in group C was significantly higher than C individuals(P<0.05); in male decreased with child-pugh increasing and patients in group A was significantly higher than C individuals(P<0.05), while there shows no significantly difference in female individuals(P>0.05).The extracellular water and skeletal muscle mass showed no significant difference between3groups even in different genders(P>0.05).1.3Resting energy expenditure(REE)Patients in group B showed a higher REE measured values level than that in group A (P>0.05); patients in group B showed a higher REE measured values level than that in group A and C both in male and female(P<0.05).Compared with REE predictive value, individuals in group A and B showed a higher level than REE measured values(P<0.05), individuals had a higher REE measured values compared with REE predictive value in group B in male and group A and B in female(P<0.05)1.4Serum albumin, hemoglobin, the level of lymphocyte countThe Serum albumin level decreased significantly with child-pugh increasing (P <0.05). The hemoglobin lever decreased significantly with child-pugh increasing and individuals in group C was significantly lower than A and B individuals(P<0.05)Individuals in group B had a significant higher level of lymphocyte count than individuals in group A(P<0.05) while individuals in group A and B showed no significance compared with individuals in group C(P>0.05).1.5Serum prealbumin,transferrin, fibronectin, retinol-binding protein levelThe Serum prealbumin and transferrin level decreased significantly with child-pugh increasing (P<0.05).The fibronectin lever decreased significantly with child-pugh increasing and individuals in group C was significantly lower than A and B individuals(P<0.05).Individuals in group B had a significant higher level retinol-binding protein than individuals in group A(P<0.05) while individuals in group A and B showed no significance compared with individuals in group C(P>0.05).1.6Relationship of grip strength and other indicatorsThere is no correlation between Grip strength and the level of serum albumin, prealbumin, hemoglobin and body fat content. But positively correlated with skeletal muscle content and arm muscle circumference (P<0.01).2. The impact of nutritional intervention in patients with cirrhosis on bodycompositionAfter taking oral nutritional supplements for14days, body weight, body mass index, extracellular fluid, total body water, swelling index of cirrhotic patients significantly decreased compared with the previous (P<0.05), whereas intracellular fluid, protein, skeletal muscle and body fat showed no significantly difference (P>0.05).Conclusions:1. As disease consuming and lacking of energy and nutrients patients with cirrhosis were suffered from malnutrition (chronic disease and starvation-related malnutrition/protein-energy malnutrtion) whose symptom is abnormal distribution of water, reduced protein content, fat, skeletal muscle, insufficient strength, decreased serum protein level.2. There showed a disorderd metabolize in patients with cirrhosis. Due to the severe stress in the body the energy consumption is more intense in patients with cirrhosis.3. Adding oral nutritional supplements can restore the moisturedistribution in patients with cirrhosis, can improve the nutritionalstatus of patients... |
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