Increased intestinal permeability in malnourished patients with liver cirrhosis

BACKGROUND/OBJECTIVE

Malnutrition is a prominent feature in liver cirrhosis, with deleterious impact on clinical outcome. The objective of this study is to investigate whether malnutrition is associated with increased gastrointestinal permeability in liver cirrhosis reflected by altered urinary excretion of non-metabolizable sugar probes.

SUBJECTS/METHODS

Patients with advanced liver cirrhosis (Child Pugh Score B or C) were recruited. Nutritional status was determined according to the Subjective Global Assessment. Intestinal permeability was assessed by measuring the urinary excretion of orally administered, non-metabolized sugar probe molecules. The lactulose/mannitol ratio served as marker for intestinal permeability and reflects non-carrier-mediated transcellular and paracellular transport of the small intestine during the first 5 h. Sucrose recovery in urine within the first 5 h reflects gastroduodenal permeability; sucralose recovery in urine 5-26 h after consumption reflects colonic permeability.

RESULTS

Sixty-four patients (56.7±10.8 years; 33% female) were included in the study. Twenty-one patients were considered well nourished according to the Subjective Global Assessment, 23 moderately nourished and 20 patients severely malnourished; 74% had alcoholic liver disease and 67% had cirrhosis stage Child C. Gastroduodenal and colonic permeability was significantly increased in patients with liver cirrhosis compared with 63 healthy controls (0.23±0.22 and 1.37±1.42% vs 0.14±0.10 and 0.41±0.72% in controls), but not different between well and malnourished subjects. Small intestinal permeability (lactulose/mannitol ratio) was increased in all patients (0.069±0.055%) and further increased in malnourished patients (0.048±0.031% vs 0.084±0.061%, P=0.004) due to decreased mannitol recovery only.

CONCLUSIONS

Gastric, small intestinal and even colonic permeability was altogether increased in liver cirrhosis, and malnutrition was associated with further increased small intestinal permeability indicative of villous atrophy.

The impact of self-perceived masticatory function on nutrition and gastrointestinal complaints in the elderly

OBJECTIVES

Impaired masticatory function is generally considered to be a contributing factor in the development of malnutrition (1, 2). Furthermore, the exclusion of essential and high-fibre foods from the subjects' diets, due to chewing problems, may induce gastrointestinal disorders (3-5).

OBJECTIVE

The impact of masticatory function on malnutrition and gastrointestinal symptoms was evaluated.

DESIGN, SETTING, AND PARTICIPANTS

This prospective cross-sectional study was conducted in four nursing homes in Berlin, Germany. 119 residents (mean 86, ± 8.0 years, 62-102) took part in the study.

MEASUREMENTS

Dental status, denture quality, prosthetic condition as well as masticatory ability and gastrointestinal symptoms were evaluated by clinical examination or interview. Nutritional state was determined according to Mini Nutritional Assessment (MNA).

RESULTS

The mean Body Mass Index was 24.4, ±4.9 kg/m² (17% < 20 kg/m²). The mean MNA was 22.5, ±4.3, 51.3% below normal. 54.5% of the dentures were poorly fitting. No significant relationships were found between the MNA and dental parameters except loose fit of dentures. However, there was significantly more food avoidance among the subjects with stated chewing problems, discomfort with dentures or ill-fitting dentures and there were significantly more digestive complaints among this group.

CONCLUSIONS

Impairments of masticatory function may lead to food avoidance and to a higher incidence of digestive complaints.

Cognitive function is associated with body composition and nutritional risk of geriatric patients

BACKGROUND

Most patients with dementia lose body weight over the course of the disease. Yet it is not known whether this weight loss is predominantly in the form of fat-free mass (FFM) or fat mass (FM), the latter of which one would expect if the weight loss were caused simply by a chronic decrease of energy intake.

OBJECTIVES

To determine body composition and nutritional risk in geriatric patients and their association with cognitive function.

DESIGN

A retrospective, cross-sectional single-center database analysis.

METHODS

We analyzed 4,095 consecutive geriatric hospital patients for body composition, nutritional risk, need of care and cognitive function using bioelectric impedance analysis, NRS 2002, Barthel Index and Mini Mental State Examination.

RESULTS

Subjects with cognitive dysfunction showed significant lower body weight, body mass index (BMI), FM, fat mass index, FFM and fat-free mass index and a higher NRS score compared to cognitively intact subjects. Mean body weight decreased 10.2%, mean FM decreased 21.1%, mean FFM decreased 5.9% and mean NRS 2002 score increased from 2.1 to 3.0 points with increasing cognitive deterioration. A multivariate analysis revealed that cognitive dysfunction, age and female gender were all significant risk factors for a low body mass index and a low fat mass index. Age, male gender and need of care, but not cognitive dysfunction, were risk factors for a low fat-free mass index.

CONCLUSION

Dementia patients seem to lose predominantly fat mass with weight loss. Female dementia patients are at a higher nutritional risk than male patients, presumably as a result of their different social situation in old age. That is why the nutritional state of female patients with dementia requires special attention.