Evaluation of nutritional indicators and body composition in patients with advanced liver disease enrolled for liver transplantation

The use of phase angle in patients with digestive and liver diseases

Diseases of the liver and the digestive system can lead to malnutrition through an action of reduced food intake or nutrient use, inflammation and impaired metabolism, which result in substantial changes in body composition. Frequently, malnutrition manifests itself with weight loss and reduced muscle mass. However, weight loss and body mass index lack sensitivity to detect the loss of muscle mass and are not informative in distinguishing body water compartments and in characterizing their distribution. This issue is particularly relevant to these two disease models, which are frequently associated with fluid volume imbalances. Phase angle is a useful indicator for cell membrane integrity, water distribution between the intracellular and extracellular spaces and prediction of body cell mass as it is described by measured components of electrical impedance. Malnutrition, inflammation and oxidative stress impair electric tissue properties leading to lower values of PhA. In patients with inflammatory bowel and liver diseases, PhA was consistently found to be related to nutritional status and body composition, particularly the depletion of lean body mass and sarcopenia. It has been associated with prognosis, disease stage and severity and found to be helpful in monitoring fluid shifts and response to interventions.

An specific photoelectrochemical sensor based on pillar[5]arenes functionalized gold nanoparticles and bismuth oxybromide nanoflowers for bovine hemoglobin recognition

In this work, the ultrasensitive photoelectrochemical (PEC) sensor for the detection of bovine hemoglobin (BHb) was developed based on water-soluble pillar[5]arenes (WP5) functionalized gold nanoparticles (Au NPs) and bismuth oxybromide (BiOBr) nanoflowers (Au@WP5/BiOBr). The photoelectrical signal of dopamine (DA) was decreased after adding the different concentrations of BHb due to the formation of hydrogen bond between the COOH groups of BHb molecules and the NH₂ group of DA, which could achieve the indirect detection of BHb. Benefiting from the photo-generated electron-holes of BiOBr nanoflowers, the localized surface plasmon resonance (LSPR) effect of Au NPs, the host-guest interaction of WP5 between and DA, the PEC sensor showed a specificallyrecognize toward BHb with a wide detection range of 1.0 × 10^-11-1.0 × 10^-1 mg/mL and a detection limit of 4.2 × 10^-12 mg/mL (S/N = 3). Additionally, the proposed PEC sensor also displayed good stability, remarkable selectivity and provided a promising strategy of design pillar[5]arenes functionalized photoelectric activity nanomaterials for PEC sensing application.

Ultrasensitive Graphene-Based Nanobiosensor for Rapid Detection of Hemoglobin in Undiluted Biofluids

Detection of hemoglobin (Hb), a critical part of the biological system that is responsible for oxygen transportation, is of great significance on clinical diagnosis of various diseases. Particularly, time-efficient Hb detection under nanomole levels has drawn much attention in recent years. Herein, we present a graphene field effect transistor (GFET)-based aptameric nanobiosensor for rapid detection of Hb in undiluted biofluids including serum and urine and for the first time use polyethylenimine (PEI), a kind of comparatively low-cost polymer consisting of numerous amino groups, which can be directly linked with the anchor molecule without any pretreatment as the graphene surface passivation agent. Experimental results indicate the PEI-modified graphene aptameric nanobiosensor can respond to the Hb concentration change in a few minutes (6-8 min) with estimated detection limits of 10.6 fM in 1× PBS, 14.2 fM in undiluted serum, and 11.9 fM in undiluted urine, respectively. Further, considering the potential use of our sensor for implantable and wearable applications, we also examine the sensing performance of the sensor fabricated on an ultrathin flexible polyethylene terephthalate (PET) substrate. The Hb detection results are almost invariable even after 100 cycles of cyclic extension by 120% or 100 cycles of bending with a radius of 1 mm. Hence, our sensor holds great potential for accurate monitoring of nanomole levels of Hb in clinical applications.

Dietary Interventions in Liver Cirrhosis

Liver cirrhosis is associated with significant nutritional risks that often result in serious hepatic complications and poor survival rates. Diet is an important but underutilized aspect in the treatment modality of cirrhosis. Therefore, the aims of this review are to ascertain nutritional risks associated with its pathophysiology and to summarize existing evidence that support dietary recommendations for managing this patient population. Alterations in substrate utilization for energy production is a main feature of liver cirrhosis, resulting in increased catabolism of protein stores and a predisposition toward protein-energy malnutrition, even in the early stages of the disease. The body of evidence suggests that a high energy and protein (>1.2 g/kg body weight/d) diet consumed frequently and late in the evening is effective in improving nutritional status of these patients and has been associated with improved hospitalization and mortality rates. The use of branched-chain amino acid supplementation shows promise in reducing cirrhosis-related complications but are currently limited by adverse gastrointestinal symptoms and poor palatability. Furthermore exploration of dietary manipulation of branched-chain amino acid warrants further examination. Evidence is also accumulating that protein intake should not be restricted in patients with hepatic encephalopathy with earlier studies of protein restriction neglecting to account for the relative increase in fermentable fiber which would reduce the absorption of ammonia into the portal system in a way similar to supplementation with lactulose. Finally, a major finding of this review is the need to improve the quality and quantity of dietary intervention studies for patients with liver cirrhosis, particularly with the use of partial or whole dietary sources. In conclusion, dietary management of cirrhosis is not a one-size fits all approach but should be implemented earlier on in the treatment algorithm to improve the clinical prognosis of cirrhosis.

A Comprehensive Review of Bioelectrical Impedance Analysis and Other Methods in the Assessment of Nutritional Status in Patients with Liver Cirrhosis

It is assumed that approximately 24–66% of patients with liver cirrhosis develop malnutrition. Numerous pathological processes lead to serious disorders of nutritional status in this group of patients. Malnutrition in the course of liver cirrhosis is associated with increased morbidity, complications, and low quality of life. Under these conditions, detection of malnutrition is of crucial importance. This review explores the complex mechanisms that lead to malnutrition in the course of liver cirrhosis and focuses on methods used in the assessment of nutritional status in cirrhotic patients. Among others, the role of bioelectrical impedance is highlighted. This noninvasive tool is promising and quite an accurate method of estimating body composition.

Malnutrition in alcoholic cirrhosis patients

Cirrhosis is a typical representative of end-stage liver diseases. Cirrhotic patients have higher nutritional risk and different degrees of malnutrition, which are closely related to the degree of liver injury and seriously affect prognosis. Compared to patients with hepatitis B cirrhosis, the abnormal energy and substance metabolism in patients with alcoholic cirrhosis is more prominent, and even equivalent to the metabolic status of hepatitis B liver failure. This may be related to the role of alcohol in the body's energy and substance metabolism. Therefore, early reasonable individualized nutrition therapy can effectively improve liver function and nutritional status, reduce the incidence of complications, and ultimately improve prognosis.

Malnutrition in cirrhosis increases morbidity and mortality

BACKGROUND AND AIMS

Malnutrition is frequent in patients with cirrhosis and is associated with complications like ascites, hepatic encephalopathy, infections, and death. We determined the prevalence of malnutrition by various methods and its clinical importance in patients with cirrhosis.

METHODS

Consecutive patients of cirrhosis from August 2013 to February 2015 were assessed. Nutritional status was assessed by traditional model (mid-arm circumference, triceps skinfold thickness, serum albumin, creatinine height index, total lymphocyte count), handgrip, and body composition analysis measuring skeletal muscle mass and body fat mass. All patients were followed up for 12 months to assess the outcome.

RESULTS

247 patients (age 42.10 ± 10.14 years, 81% male) were included in the study. Etiology of cirrhosis was alcohol in 53% patients. Prevalence of malnutrition was 59.5% according to traditional model, 66.8% by body composition analysis and 71.4% by handgrip. Nutritional status was poor in alcoholic cirrhotics versus nonalcoholics as assessed by triceps skinfold thickness (9.33 ± 2.9 vs 11.64 ± 3.5 mm; P = 0.001), serum albumin (25.1 ± 4 vs 28.1 ± 4 g/L; P = 0.001), and body fat mass (7.6 ± 3.1 vs 8.7 ± 3.3 kg; P = 0.008). Prevalence of malnutrition was 12/27 (44.5%), 96/131 (73.3%) and 84/89 (94.4%) in Child's class A, B, and C respectively. Complications requiring hospitalization (71.3% vs 38.2%; 0.002) and mortality (41.1% vs 18.2%; P = 0.001) were more in malnourished patients compared to well nourished. Nutritional assessment parameters significantly correlated with the liver disease severity (P < 0.05).

CONCLUSIONS

Prevalence of malnutrition is high in patients with cirrhosis. It is associated with increased complications and mortality.

Body composition and morphological assessment of nutritional status in adults: a review of anthropometric variables

Evaluation of body composition is an important part of assessing nutritional status and provides prognostically useful data and an opportunity to monitor the effects of nutrition-related disease progression and nutritional intervention. The aim of this narrative review is to critically evaluate body composition methodology in adults, focusing on anthropometric variables. The variables considered include height, weight, body mass index and alternative indices, trunk measurements (waist and hip circumferences and sagittal abdominal diameter) and limb measurements (mid-upper arm and calf circumferences) and skinfold thickness. The importance of adhering to a defined measurement protocol, checking measurement error and the need to interpret measurements using appropriate population-specific cut-off values to identify health risks were highlighted. Selecting the optimum method for assessing body composition using anthropometry depends on the purpose (i.e. evaluating obesity or undernutrition) and requires practitioners to have a good understanding of both practical and theoretical limitations and to be able to interpret the results wisely.