Nutritional Considerations for Children with Liver Disease.

The importance of dietitians in dialysis units is indisputable and mandatory in Brazil, but little is known about the practices adopted by these professionals. To know practices adopted in routine nutritional care, focusing on nutritional assessment tools and treatment strategies for people at risk or diagnosed with malnutrition. Electronic questionnaire disseminated on social media and messaging applications. It included questions that covered dietitians' demographic and occupational profile characteristics and of the dialysis unit, use and frequency of nutritional assessment tools, nutritional intervention strategies in cases of risk or diagnosis of malnutrition, prescription and access to oral supplements. Twenty four percent of the Brazilian dialysis units (n = 207) responded electronically. The most used nutritional assessment tools with or without a pre-established frequency were dietary surveys (96%) and Subjective Global Assessment (83%). The strategies in cases of risk or presence of malnutrition used most frequently (almost always/always) were instructions to increase energy and protein intake from foods (97%), and increasing the frequency of visits (88%). The frequency of prescribing commercial supplements with standard and specialized formulas was quite similar. The availability of dietary supplements by the public healthcare system to patients varied between regions. Most dietitians use various nutritional assessment tools and intervention strategies in cases of risk or malnutrition; however, the frequency of use of such tools and strategies varied substantially.

Chronic liver diseases are very common worldwide and represent a major healthcare issue (GBD 2013 Mortality and Causes of Death Collaborators, 2015). Chronic liver diseases are characterized by inflammation of the liver, which may be secondary to distinct etiological factors, including hepatitis C or B infection, increased alcohol consumption, or non-alcoholic fatty liver disease (NAFLD). This article is protected by copyright. All rights reserved.

Covering the Cover

After completing this article, readers should be able to: 1. Describe the caloric requirements of a neonate who has chronic liver disease. 2. Identify the vitamin and mineral deficiencies associated with cholestasis and the methods used to correct these deficits. 3. Describe the relationship between total parenteral nutrition and the development of chronic liver disease. 4. Delineate the relationship between malnutrition at the time of liver transplantation and subsequent morbidity and mortality. 5. List the best measurements of nutrition assessment in infants who have chronic liver disease. The liver is involved in many of the body’s metabolic processes, including: regulation of protein, fat, and carbohydrate metabolism; vitamin storage and activation; and detoxification and excretion of waste products. The healthy liver synthesizes and excretes bile salts. With cholestatic liver diseases, poor bile flow results in fat malabsorption because micelles, which solubilize long-chain fatty acids, cannot form without bile salts. Fat malabsorption results in enteric losses of the fat-soluble vitamins A, D, E, and K. Impaired liver function can lead to nutrient deficiencies and eventually protein-energy malnutrition. All of these factors, combined with the common symptoms of anorexia and poor dietary intake, make malnutrition common in chronic liver disease, particularly if it occurs in infants, who are more vulnerable to the debilitating effects of malnutrition because of their higher energy and growth requirements. A wide range of deficits occurs in most chronic liver diseases of children (Table 1⇓ ). Malnutrition itself may induce further derangements of liver function because the liver requires energy for a number of synthetic, storage, and detoxification functions. View this table: Table 1. Nutritional Risk Factors in Acute and Chronic Liver Disease The need for aggressive, early nutrition support in neonates has been well established and discussed extensively. Some centers routinely use a “standardized” approach to nutrition support; we use a “tailored” approach that entails parenteral or …

Contribution of metabolic factors to alanine aminotransferase activity in persons with other causes of liver disease

BackgroundSchizophrenia is a complex mental disorder with a chronic course. The atypical antipsychotics represented by lurasidone are commonly used in chronic schizophrenia, and its mechanism of action determines the superiority of efficacy and safety. However so far, there are still some adverse reactions, of which the more significant are lethargy, nausea, and sedentary inability. In view of these situations, we will combine nutrition intervention with the use of lurasidone to eliminate adverse reactions and provide help for the formulation of treatment plans.Subjects and MethodsThe study will be based on whether to add nutrition intervention as a difference set up control experiment, the experimental group using lurasidone combined nutrition intervention, the control group using lurasidone single factor intervention. The patients who received treatment in the psychiatric department of our hospital from March 2021 to March 2022 were selected as the research objects, and the efficacy and adverse reactions of the patients were monitored during the treatment. The efficacy will be judged by the medical scale of symptom severity of patients with schizophrenia (Positive and Negative Syndrome Scale, PANSS) and the monitoring data will be statistically analyzed by SPSS.ResultsWith the treatment, the results of the Experimental group and the control group are shown in Table 1. The PANSS scores of the two groups finally reached a range of 30-40, with a difference of 4. The incidence of nausea, lethargy and sedentary disorder in adverse symptoms was higher in the control group, and the difference was statistically significant (P < 0.05). It shows that nutritional intervention cannot affect the efficacy of psychosis itself, yet can alleviate the adverse symptoms after medication.Table 1.Efficacy and adverse reactions of the two groupsGroupPANSSNauseaSomnolenceSedentary disorderExperimental group (n=46)32.3±4.13(6.5%)4(8.7%)2(4.3%)Control group (n=41)36.3±5.28(19.5%)6(14.6%)5(12.2%)P>0.05<0.05<0.05<0.05ConclusionsThe group of schizophrenics is not limited to a certain age. Therefore, adverse symptoms caused by psychotropic drugs need to be considered in the practice. Symptoms in the course of the patient’s disease can be used as a treatment optimization path. Although the nutrition intervention strategy has no direct impact on the indicators of mental illness, the prevention of adverse symptoms during treatment can improve the actual experience of patients. In the future, the nutrition strategy will be adaptively optimized to improve the rehabilitation effect of chronic schizophrenia.AcknowledgementsThe research is supported by: Key Discipline of Nutrition and Food Hygiene of Changsha Medical university Quality Engineering Construction Project+2016; Study on Intervention Effect of Mindfulness Acceptance Stress Project on Nurses Aid to COVID-19+Outstanding Youth Project of Scientific Research of Hunan Education Department +2020(264)20B070.

Glycemic control alone does not reduce cardiovascular events in patients with type 2 diabetes (T2D), and routine screening of all T2D patients for asymptomatic coronary artery disease (CAD) is not effective for preventing acute cardiac events. We examined the effectiveness of an aggressive screening protocol for asymptomatic CAD in T2D patients with advanced vascular complications.We designed a 3-year cohort study investigating the effectiveness of the aggressive coronary screening for T2D patients with advanced vascular complications and no known coronary events using propensity score adjusted analysis at a national center in Japan. Eligibility criteria included T2D without known coronary events and with any 1 of the following 4 complications: advanced diabetic retinopathy, advanced chronic kidney disease, peripheral artery disease, or cerebrovascular disease. In the aggressive screening group (n = 122), all patients received stress single photon emission computed tomography and those exhibiting myocardial perfusion abnormalities underwent coronary angiography. In the conventional screening group (n = 108), patients were examined for CAD at the discretion of their medical providers. Primary endpoint was composite outcome of cardiovascular death and nonfatal cardiovascular events.Asymptomatic CAD with ≥70% stenosis was detected in 39.3% of patients completing aggressive screening. The proportions achieving revascularization and receiving intensive medical therapy within 90 days after the screening were significantly higher in the aggressive screening group than in the conventional screening group [19.7% vs 0% (P < 0.001) and 48.4% vs 9.3% (P < 0.001), respectively]. The cumulative rate of primary composite outcome was significantly lower in the aggressive screening group according to a propensity score adjusted Cox proportional hazards model (hazard ratio, 0.35; 95% confidence interval, 0.12-0.96; P = 0.04).Aggressive coronary screening for T2D patients with advanced vascular complications reduced cardiovascular death and nonfatal cardiovascular events.

The Impact of Liver Disease on Growth and Nutrition

Fatigue in Cirrhosis: Is Transplant the Answer?

Within the last 60 years, pediatric hepatology has seen many advances in improvement in timely diagnosis and management of chronic liver disease and also in liver transplantation. Growth failure and malnutrition have always been important factors in the treatment of children with liver disease, specifically cholestatic liver diseases. The liver has a central function in nutrient metabolism, and the abnormalities seen in chronic liver disease result in nutritional and metabolic deficiencies. Nutritional needs are dependent on the type of liver disease, age of the patient, and whether the disease is acute or chronic. In the setting of acute liver disease, such as acute viral hepatitis, malnutrition is unusual; however, in fulminant liver failure, nutritional modifications are needed to manage hepatic encephalopathy. Chronic liver disease may be cholestatic or noncholestatic and in most instances is associated with malnutrition. Cholestatic injury to the liver reflects a diverse group of diseases, resulting from biliary obstruction, disorders of bile synthesis or transport, metabolic and endocrine disorders, infections, and toxic effects. The most common is biliary atresia, occurring in approximately 1 of 10,000 live births; it is the most common indication for liver transplantation in children. Patients have relatively progressive hepatic disease and, often, poor nutritional status, making preoperative management of malnutrition a challenge. Malnutrition is a negative prognostic indicator of overall survival, and the inability to improve nutritional status before surgery increases the risk of postoperative complications and mortality. Adequate nutrition allows for growth, improved immunologic status, and improved transplantation outcomes. Nutritional status in the setting of liver disease can be difficult to assess.Weight alone is not a sufficient marker for nutritional status, especially if the patient has ascites or organomegaly: fluid retention and a disproportionately large organ may result in substantial weight gain, whereas the overall nutritional status is actually poor. The ascites and organomegaly, as well as portal hypertension, can also contribute to poor oral tolerance, furthering the failure to gain appropriate weight for age and preventing the often needed catch-up weight gain. Although serial abdominal circumference measurement may aid in determining whether weight gain is secondary to ascites, it is an imprecise way of differentiating true weight gain from fluid gain. More accurate measures include triceps skinfolds and middle upper arm circumferencemeasurements, with standards for age available from the World Health Organization. These measurements, however, require calipers and training in proper technique. Peripheral edema is a potential cause of overestimation of both measures and if present needs to be considered. Both the child’s age and the specific disease affecting the liver contribute to the issues of nutrition and growth facing each patient. Assessment and support are key components of effective care, which is best performed by a team of physicians AUTHOR DISCLOSURE Drs Cameron and Kogan-Liberman have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Nutritional considerations and management of the child with liver disease

Nonalcoholic fatty liver disease (NAFLD) is currently the most common cause of chronic liver disease worldwide and is present in a third of the general population and the majority of individuals with obesity and type 2 diabetes. The less severe form of the disease is relatively common and can be somewhat benign. However, in certain individuals, the disease can progress to the more severe nonalcoholic steatohepatitis (NASH), resulting in a poor health, a poor prognosis, and a significant healthcare burden. In recent years, there has been a major research effort focused on identifying the factors that promote NALFD disease progression, and as a result there has been a significant advancement in our understanding of the interaction between nutrition and the molecular mechanisms that regulate hepatic lipid homeostasis. Nonetheless, the capacity of the maternal diet to alter these fundamental metabolic pathways and thus prime the development of severe fatty liver disease in the adult liver has proved to be one of the most striking findings from this body of research. Since the prudence of the maternal diet has wavered in recent years, this may explain why NAFLD—once commonly associated with older individuals—is now increasingly common in young adults, children, and adolescents. In the following chapter, we aim to review the current hypothesis surrounding the mechanisms that underlie the developmental priming of NAFLD. We will also explore how these novel insights have facilitated the emergence of promising new pharmacological and nutritional intervention strategies.

COVID-19 and Social Determinants of Health in Gastroenterology and Hepatology

This issue marks the beginning of the 5-year tenure of a new group of editors of HEPATOLOGY who will assume the responsibility from an extremely productive and successful group of editors led by Dr. Andy Blei. Doctor Blei and his colleagues helped to further develop HEPATOLOGY into the world's premier journal for reporting advances in liver disease. HEPATOLOGY is an important venue for discussions of the basic sciences underlying liver disease as well as the clinical aspects of acute and chronic liver diseases. Furthermore, HEPATOLOGY has become a forum for discussions about policies related to societal issues regarding liver disease and health care policy as it relates to the liver. In addition, HEPATOLOGY serves as an important educational arm of AASLD. The vision of the new editors of HEPATOLOGY is in perfect alignment with that of AASLD's recently published vision and mission statement. The vision of AASLD is to prevent liver disease and the mission is to advance the science and practice of hepatology, thereby promoting liver health and optimal care of patients with liver and biliary tract disease. There are several strategic goals of the organization that HEPATOLOGY is optimally situated to serve. These include the promotion of basic and clinical research on liver and biliary tract disease, education of healthcare professionals, identification of public policy issues, and improving the training of professionals committed to the science and practice of hepatology. It is our intent to continue to build on Dr. Blei's outstanding performance and further ensure that the strategic goals of AASLD are embraced. HEPATOLOGY will continue to be a major source of information for new advances in the field, whether these are basic science or clinical research covering diagnoses, management of liver diseases, or complications. Furthermore, HEPATOLOGY should continue to be a forum for discussions about public policy as it relates to liver diseases, again consistent with the AASLD's strategic plan to be active in public policy and in promoting public health. HEPATOLOGY's reach continues to be global and it is expected that its international scope will continue to increase. HEPATOLOGY continues to attract numerous manuscripts, and it is our hope that the submission rate will continue to increase. We currently receive 1600-1800 articles per year, and the acceptance rate has hovered around 20%. Currently, about one-third of the papers would be considered clinical and two-thirds basic or translational. Our field is characterized, perhaps more than any other, by a robust interplay of basic sciences through translational research into clinical practice. A continued goal of the editors of HEPATOLOGY is to merge these 3 important components of our field into 1 source. We anticipate expanding the number of papers per issue by 15%-20%, in recognition of the increased research activities focused on liver disease and the continued popularity of this journal as a source for publishing these findings. We will strive to provide an excellent balance between clinical and more basic mechanistic information regarding liver disease and anticipate that the extra pages will go toward publishing the increasing number of excellent clinical papers submitted to this journal. HEPATOLOGY will include editorials on pertinent articles. We also have a goal of 2 review articles per month, 1 on a clinical topic and 1 a basic or translational topic. A group of 3 members of our editorial board will be responsible for surveying the hepatology literature outside our journal to keep readers informed via “Hepatology Elsewhere”. Drs. Kris Kowdley, Geoff McCaughan, and Christian Trautwein will each be responsible for a monthly review of papers published elsewhere that our readers may not have otherwise encountered but would be important to bring to our attention along with editorial board commentary. Our group of Associate Editors consists of outstanding investigators and clinicians from around the globe: These are all active investigators, experts in their fields, highly energetic, and committed to the success of HEPATOLOGY. We have already had the opportunity to verify their expertise, dedication, and commitment to the work of HEPATOLOGY. The journal will continue to be published with the support of a very strong central office led by Greg Bologna, assisted by Alan Manton and Kareytis Martinez, using Manuscript Central. Our publisher, John Wiley & Sons, has continued to be highly supportive of the efforts of the editors of HEPATOLOGY. We look forward over the next 5 years to our readership's frequent submissions and also to the expert reviewer comments. Our commitment is to have the review cycle time be as short as possible. Our goal is that all reviews are to be completed within 2 weeks. We hope all these efforts will continue to keep HEPATOLOGY at the cutting edge and help it become an even more vital resource for those with interest in the study of liver disease.

Statins Are Safe for the Treatment of Hypercholesterolemia in Patients With Chronic Liver Disease