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Bannert K, Karbe C, Förster RH, Sautter LF, Meyer F, Valentini L, Wiese ML, Ehlers L, Berlin P, Jaster R, Aghdassi AA, Lerch MM, Lamprecht G. Orally compensated short bowel patients are thin, potentially malnourished but rarely sarcopenic. Clin Nutr 2023:S0261-5614(23)00160-7. [PMID: 37311685 DOI: 10.1016/j.clnu.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/09/2023] [Accepted: 05/23/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND AIM In short bowel syndrome, insufficient absorptive capacity of the remnant bowel may lead to metabolic and nutritional consequences including electrolyte disturbances, severe diarrhea and malnutrition. While intestinal failure requires parenteral nutrition, short bowel patients with intestinal insufficiency (SB/II) have achieved oral autonomy. The aim of this exploratory study was to assess the nutritional, muscular and functional status of orally compensated SB/II patients. METHODS 28 orally compensated SB/II patients with a mean of 46 months after termination of parenteral nutrition and 56 age- and sex-matched healthy controls (HC) were compared regarding anthropometric parameters, body composition using bioelectrical impedance analysis, handgrip strength and gait speed, blood parameters as well as nutritional intake and physical activity using validated questionnaires. Malnutrition and sarcopenia were diagnosed according to the criteria of the GLIM or EWGSOP2. RESULTS SB/II patients had lower body mass index (BMI) and anthropometric parameters than HC but were within the normal weight range. The GLIM algorithm operationally diagnosed malnutrition in 39% (n = 11) of SB/II patients. Reduced skeletal muscle mass index and phase angle were rarely accompanied by a reduction of handgrip strength below cut-off values and the subsequent diagnosis of sarcopenia in SB/II patients (15%, n = 4). Compared to 11% of HC, 37% of SB/II patients had low physical activity level. Female SB/II patients had higher caloric and macronutrient intake. Caloric intake negatively correlated with body weight indicating compensatory hyperphagia in patients with lower body weight. Some of the SB/II patients showed signs of dehydration. CONCLUSIONS Orally compensated SB/II patients are thinner than HC but have mostly normal BMI. Malnutrition is frequently diagnosed but may be overestimated due to the underlying malabsorption and its interplay with hyperphagia. Muscle mass is often reduced but is rarely accompanied by functional impairment leading to sarcopenia diagnosis. Thus, SB/II patients long term after termination of parenteral support may be malnourished but usually do not develop sarcopenia.
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Affiliation(s)
- Karen Bannert
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Cathleen Karbe
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Robert H Förster
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Lea F Sautter
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Fatuma Meyer
- University of Applied Sciences Neubrandenburg, Institute for Evidence-Based Dietetics, Germany
| | - Luzia Valentini
- University of Applied Sciences Neubrandenburg, Institute for Evidence-Based Dietetics, Germany
| | - Mats L Wiese
- University Medicine Greifswald, Department and Polyclinic of Internal Medicine A, Germany
| | - Luise Ehlers
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Peggy Berlin
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Robert Jaster
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany
| | - Ali A Aghdassi
- University Medicine Greifswald, Department and Polyclinic of Internal Medicine A, Germany
| | - Markus M Lerch
- LMU University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Georg Lamprecht
- Rostock University Medical Center, Department of Medicine II, Division of Gastroenterology and Endocrinology, Germany.
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Meyer F, Bannert K, Wiese M, Esau S, Sautter LF, Ehlers L, Aghdassi AA, Metges CC, Garbe LA, Jaster R, Lerch MM, Lamprecht G, Valentini L. Molecular Mechanism Contributing to Malnutrition and Sarcopenia in Patients with Liver Cirrhosis. Int J Mol Sci 2020; 21:E5357. [PMID: 32731496 PMCID: PMC7432938 DOI: 10.3390/ijms21155357] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 02/07/2023] Open
Abstract
Liver cirrhosis is frequently accompanied by disease-related malnutrition (DRM) and sarcopenia, defined as loss of skeletal muscle mass and function. DRM and sarcopenia often coexist in cirrhotic patients and are associated with increased morbidity and mortality. The clinical manifestation of both comorbidities are triggered by multifactorial mechanisms including reduced nutrient and energy intake caused by dietary restrictions, anorexia, neuroendocrine deregulation, olfactory and gustatory deficits. Maldigestion and malabsorption due to small intestinal bacterial overgrowth, pancreatic insufficiency or cholestasis may also contribute to DRM and sarcopenia. Decreased protein synthesis and increased protein degradation is the cornerstone mechanism to muscle loss, among others mediated by disease- and inflammation-mediated metabolic changes, hyperammonemia, increased myostatin and reduced human growth hormone. The concise pathophysiological mechanisms and interactions of DRM and sarcopenia in liver cirrhosis are not completely understood. Furthermore, most knowledge in this field are based on experimental models, but only few data in humans exist. This review summarizes known and proposed molecular mechanisms contributing to malnutrition and sarcopenia in liver cirrhosis and highlights remaining knowledge gaps. Since, in the prevention and treatment of DRM and sarcopenia in cirrhotic patients, more research is needed to identify potential biomarkers for diagnosis and development of targeted therapeutic strategies.
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Affiliation(s)
- Fatuma Meyer
- Department of Agriculture and Food Sciences, Neubrandenburg Institute for Evidence-Based Dietetics (NIED), University of Applied Sciences Neubrandenburg, 17033 Neubrandenburg, Germany; (F.M.); (S.E.); (L.F.S.)
| | - Karen Bannert
- Division of Gastroenterology and Endocrinology, Department of Internal Medicine II, University Medicine Rostock, 18057 Rostock, Germany; (K.B.); (L.E.); (R.J.); (G.L.)
| | - Mats Wiese
- Division of Gastroenterology, Endocrinology and Nutritional Medicine, Department of Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (M.W.); (A.A.A.); (M.M.L.)
| | - Susanne Esau
- Department of Agriculture and Food Sciences, Neubrandenburg Institute for Evidence-Based Dietetics (NIED), University of Applied Sciences Neubrandenburg, 17033 Neubrandenburg, Germany; (F.M.); (S.E.); (L.F.S.)
| | - Lea F. Sautter
- Department of Agriculture and Food Sciences, Neubrandenburg Institute for Evidence-Based Dietetics (NIED), University of Applied Sciences Neubrandenburg, 17033 Neubrandenburg, Germany; (F.M.); (S.E.); (L.F.S.)
- Division of Gastroenterology and Endocrinology, Department of Internal Medicine II, University Medicine Rostock, 18057 Rostock, Germany; (K.B.); (L.E.); (R.J.); (G.L.)
| | - Luise Ehlers
- Division of Gastroenterology and Endocrinology, Department of Internal Medicine II, University Medicine Rostock, 18057 Rostock, Germany; (K.B.); (L.E.); (R.J.); (G.L.)
| | - Ali A. Aghdassi
- Division of Gastroenterology, Endocrinology and Nutritional Medicine, Department of Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (M.W.); (A.A.A.); (M.M.L.)
| | - Cornelia C. Metges
- Institute of Nutritional Physiology ‘Oskar Kellner’, Leibniz Institute for Farm Animal Biology (FBN), 18196 Dummerstorf, Germany;
| | - Leif-A. Garbe
- Department of Agriculture and Food Sciences, University of Applied Sciences Neubrandenburg, 17033 Neubrandenburg, Germany;
| | - Robert Jaster
- Division of Gastroenterology and Endocrinology, Department of Internal Medicine II, University Medicine Rostock, 18057 Rostock, Germany; (K.B.); (L.E.); (R.J.); (G.L.)
| | - Markus M. Lerch
- Division of Gastroenterology, Endocrinology and Nutritional Medicine, Department of Internal Medicine A, University Medicine Greifswald, 17475 Greifswald, Germany; (M.W.); (A.A.A.); (M.M.L.)
| | - Georg Lamprecht
- Division of Gastroenterology and Endocrinology, Department of Internal Medicine II, University Medicine Rostock, 18057 Rostock, Germany; (K.B.); (L.E.); (R.J.); (G.L.)
| | - Luzia Valentini
- Department of Agriculture and Food Sciences, Neubrandenburg Institute for Evidence-Based Dietetics (NIED), University of Applied Sciences Neubrandenburg, 17033 Neubrandenburg, Germany; (F.M.); (S.E.); (L.F.S.)
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