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Nutritional Requirements and Support in Liver Disease

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Nutrition in Infancy

Abstract

The liver has a central role in energy metabolism, nutritional homeostasis and absorption of nutrients. Severe liver disease, whether acute or chronic, leads to multiorgan failure, which can have significant effects on growth and development in the long term. Malnutrition is common in infants and children with chronic liver disease (CLD). The pathophysiology of malnutrition in liver disease is complex and multifactorial and has extensive implications. Insufficient dietary intake is probably the most important factor and is correctable (Table 7.1). It is most severe in infants with chronic cholestatic liver disease, who are particularly vulnerable to the effects of malnutrition because of their high-energy and growth requirements [1].

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References

  1. Chin SE, Shepherd RW, Thomas BJ, Cleghorn GJ, Patrick MK, Wilcox JA, et al. The nature of malnutrition in children with end stage liver disease. Am J Clin Nutr. 1992;56:164–8.

    PubMed  CAS  Google Scholar 

  2. Beath S, Pearmain G, Kelly D, McMaster P, Mayer D, Buckels J. Liver transplantation in babies and children with extrahepatic biliary atresia. J Pediatr Surg. 1993;28(8):1044–7.

    Article  PubMed  CAS  Google Scholar 

  3. Moukarzel AA, Najm I, Vargas J, McDiarmid SV, Busutti RW, Ament ME. Effect of nutritional status on outcome of orthotopic liver transplantation in pediatric patients. Transplant Proc. 1990;22:1560–3.

    PubMed  CAS  Google Scholar 

  4. Beath S, Brook G, Kelly D, McMaster P, Mayer D, Buckels J. Improving outcome of liver transplantation in babies less than 1 year. Transplant Proc. 1994;26:180–1.

    PubMed  CAS  Google Scholar 

  5. Chin SE, Shepherd RW, Thomas BJ, Cleghorn GJ, Patrick MK, Wilcox JA, et al. Nutritional support in children with end-stage liver disease: a randomized crossover trial of a branched-chain amino acid supplement. Am J Clin Nutr. 1992;56(1):158–63.

    PubMed  CAS  Google Scholar 

  6. Nightingale S, Ng VL. Optimizing nutritional management in children with chronic liver disease. Pediatr Clin North Am. 2009;56(5):1161–83.

    Article  PubMed  Google Scholar 

  7. Beath S, Hooley I, Willis K, Johnson S, Kelly D, Booth I. Long chain triacyglycerol malabsorption. Clin Endocrinol. 1993;52:252A.

    Google Scholar 

  8. Chong SK, Lindridge J, Moniz C, Mowat AP. Exocrine pancreatic insufficiency in syndromic paucity of interlobular bile ducts. J Pediatr Gastroenterol Nutr. 1989;9(4):445–9.

    Article  PubMed  CAS  Google Scholar 

  9. Kamath BM, Loomes KM, Piccoli DA. Medical management of Alagille’s syndrome. J Pediatr Gastro Nutr. 2010;50(6):580–6.

    Article  Google Scholar 

  10. Pawłowska J, Socha P, Socha J. Nutrition in pediatric patients before liver transplantation. Rocz Panstw Zakl Hig. 2007;58(1):111–8.

    PubMed  Google Scholar 

  11. Romijn JA, Endert E, Sauerwein HP. Glucose and fat metabolism during short-term starvation in cirrhosis. Gastroenterology. 1991;100:731–7.

    PubMed  CAS  Google Scholar 

  12. Boyer Td, Manns MP, Sanyal AJ, Hellerston MM. Interaction of liver, muscle and adipose tissue in the regulation of metabolism in response to nutritional and other factors. In: The liver: biology and pathobiology. 3rd ed. New York: Raven; 1994. p. 1169–91.

    Google Scholar 

  13. Yudkoff M, Nissim I, McNellis W, Polin R. Albumin synthesis in premature infants: determination of turnover with [15N]glycine. Pediatr Res. 1987;21:49–53.

    Article  PubMed  CAS  Google Scholar 

  14. Duggan C, Watkins JB, Walker A, Miller L. The role of the liver and the non-hepatic tissues in the regulation of free amino acid levels in the blood. In: Amino acid pools A. Amsterdam: Elsevier; 1962. p. 708–9.

    Google Scholar 

  15. Powers Lee SG, Meister L. Urea synthesis and ammonia metabolism. In: Arias M, Jakoby WB, Popper H, Schalter D, Shafritz DA, editors. The liver: biology and pathobiology. New York: Raven; 1988. p. 317–30.

    Google Scholar 

  16. McCullough AJ, Mullen KD, Smanik EJ, Tabbaa M, Szauter K. Nutritional therapy and liver disease. Gastroenterol Clin North Am. 1989;18:619–43.

    PubMed  CAS  Google Scholar 

  17. Weisdorf SA, Freese DK, Fath JJ, Tsai MY, Cerra FB. Amino acid abnormalities in infants with extrahepatic biliary atresia and cirrhosis. Pediatr Gastroenterol Nutr. 1987;6:860–4.

    Article  CAS  Google Scholar 

  18. Kawaguchi T, Izumi N, Charlton MR, Sata M. Branched-chain amino acids as pharmacological nutrients in chronic liver disease. Hepatology. 2011;54(3):1063–70.

    Article  PubMed  CAS  Google Scholar 

  19. Ramaccioni V, Soriano HE, Arumugam R, Klish WJ. Nutritional aspects of chronic liver disease and liver transplantation in children. J Pediatr Gastroenterol Nutr. 2000;30(4):361–7.

    Article  PubMed  CAS  Google Scholar 

  20. Protheroe S, Jones R, Kelly DA. Evaluation of the role of branched chain amino acids in the treatment of protein malnutrition in infants with liver disease. Gut. 1995;37:A30.

    Article  Google Scholar 

  21. Mager DR, Wykes LJ, Roberts EA, Ball RO, Pencharz PB. Mild-to-moderate chronic cholestatic liver disease increases leucine oxidation in children. J Nutr. 2006;136(4):965–70.

    PubMed  CAS  Google Scholar 

  22. Duggan C, Watkins JB, Walker A, Dyke RV. Mechanisms of digestion and absorption of food. In: Gastrointestinal disease, pathophysiology, diagnosis, management. 4th ed. Philadelphia: WB Saunders; 1989. p. 1062–1088.

    Google Scholar 

  23. Carey M, Small DM, Bliss CM. Lipid digestion and absorption. Annu Rev Physiol. 1983;45:651–77.

    Article  PubMed  CAS  Google Scholar 

  24. Phan CT, Tso P. Intestinal lipid absorption and transport. Front Biosci. 2001;6:D299–319.

    Article  PubMed  CAS  Google Scholar 

  25. Beath SV, Booth IW, Kelly DA. Nutritional support in liver disease. Arch Dis Child. 1993;69:545–9.

    Article  PubMed  CAS  Google Scholar 

  26. Makrides M, Neumann M, Simmer K, Pater J, Gibson R. Are long-chain polyunsaturated fatty acids essential nutrients in infancy? Lancet. 1995;345:1463–8.

    Article  PubMed  CAS  Google Scholar 

  27. Koletzko B, Agostoni C, Carlson SE, Clandinin T, Hornstra G, Neuringer M, et al. Long chain polyunsaturated fatty acids (LC-PUFA) and perinatal development. Acta Paediatr. 2001;90:460–4.

    Article  PubMed  CAS  Google Scholar 

  28. Spray CH, Beath S, Willis KD, et al. Docosahexaenoic acid (DHA) and visual function in infants with fat malabsorption secondary to liver disease. Proceed Nutr. 1995;54:108A.

    Google Scholar 

  29. Holt RI, Jones JS, Stone NM, Baker AJ, Miell JP. Sequential changes in insulin-like growth factor I (IGF-I) and IGF-binding proteins in children with end-stage liver disease before and after successful orthotopic liver transplantation. J Clin Endocrinol Metabol. 1996;81:160–8.

    Article  CAS  Google Scholar 

  30. Bucuvalas JC, Horn JA, Slusher J, Alfaro MP, Chernausek SD. Growth hormone insensitivity in children with biliary atresia. J Pediatr Gastroenterol Nutr. 1996;23:135–40.

    Article  PubMed  CAS  Google Scholar 

  31. Holt RI, Miell JP, Jones JS, Mieli-Vergani G, Baker AJ. Nasogastric feeding enhances nutritional status in paediatric liver disease but does not alter circulating levels of IGF-I and IGF binding proteins. Clin Endocrinol. 2000;52:217–24.

    Article  CAS  Google Scholar 

  32. Quirk P, Owens P, Moyse K, Chin S, Wall C, Ballard J, et al. Insulin-like growth factors I and II are reduced in plasma from growth retarded children with chronic liver disease. Growth Regul. 1994;4:35–8.

    PubMed  CAS  Google Scholar 

  33. Pierro A, Koletzko B, Carnielli V, Superina RA, Roberts EA, Filler RM, et al. Resting energy expenditure is increased in infants and children with extrahepatic biliary atresia. J Pediatr Surg. 1989;24:534–8.

    Article  PubMed  CAS  Google Scholar 

  34. Protheroe SM, McKiernan PJ, Kelly DA. Can measurement of dietary-induced thermogenesis (DIT) predict response to nutritional intervention in infants with liver disease? Clin Nutr. 1996;15:39.

    Google Scholar 

  35. Yanofsky RA, Jackson VG, Lilly JR, Stellin G, Klingensmith III WC, Hathaway WE. The multiple coagulopathies of biliary atresia. Am J Haematol. 1984;16(2):171–80.

    Article  CAS  Google Scholar 

  36. Hogler W, Baumann U, Kelly D. Growth and bone health in chronic liver disease and following liver transplantation in children. Pediatr Endocrinol Rev. 2011;7(3):266–74.

    Google Scholar 

  37. van Mourik ID, Beath SV, Brook GA, Cash AJ, Mayer AD, Buckels JA, et al. Long term nutritional and Neurodevelopmental outcome of liver transplantation in infants aged less than 12 months. J Pediatr Gastroenterol Nutr. 2009;30(3):269–75.

    Article  Google Scholar 

  38. Waterlow J. Note on the assessment and classification of protein-energy malnutrition in children. Lancet. 1973;2:87–9.

    Article  PubMed  CAS  Google Scholar 

  39. Sokol RJ, Stall C. Anthropometric evaluation of children with chronic liver disease. Am J Clin Nutr. 1990;52:203–8.

    PubMed  CAS  Google Scholar 

  40. Baker A, Stevenson R, Dhawan A, Goncalves I, Socha P, Sokal E. Guidelines for nutritional care for infants with cholestatic liver disease before liver transplantation. Paediatr Transpl. 2007;11(8):825–34.

    Article  CAS  Google Scholar 

  41. Kumpf V. Parenteral nutrition associated liver disease in adult and pediatric patients. Nutr Clin Pract. 2006;21:279–90.

    Article  PubMed  Google Scholar 

  42. Cavicchi M, Beau P, Crenn P, Degott C, Messing B. Prevalence of liver disease and contributing factors in parenteral nutrition of intensive care patients: current thinking and future directions. Intensive Care Med. 2000;36:735–49.

    Google Scholar 

  43. Calder PC, Jensen GL, Koletzko BV, Singer P, Wanten GJ. Lipid emulsions in parenteral nutrition of intensive care patients: current thinking and future directions. Intensive Care Med. 2010;36:735–49.

    Article  PubMed  CAS  Google Scholar 

  44. Diamond IR, de Silva NT, Tomlinson GA, Pencharz PB, Feldman BM, Moore AM, et al. The role of parenteral lipis in the development of advanced intestinal failure-associated liver disease in infants: a multiple-variable analysis. J Parenter Enteral Nutr. 2011;35(5):596–602.

    Article  CAS  Google Scholar 

  45. Meijer VE, Gura KM, Le HD, Meisel JA, Puder M. Fish oil-based lipid emulsions prevent and reverse parenteral nutrition-associate liver disease: The Boston experience. J Parenter Enteral Nutr. 2009;33(5):541–7.

    Article  Google Scholar 

  46. Pittiruti M, Hamilton H, Biffi R, Macfie J, Pertkiewicz M. ESPEN guidelines on parenteral nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr. 2009;28:365–77.

    Article  PubMed  Google Scholar 

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Correspondence to Deirdre A. Kelly F.R.C.P.H., F.R.C.P., F.R.C.P.I., M.D. .

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Kelly, D.A., Protheroe, S., Clarke, S. (2013). Nutritional Requirements and Support in Liver Disease. In: Watson, R., Grimble, G., Preedy, V., Zibadi, S. (eds) Nutrition in Infancy. Nutrition and Health. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-254-4_7

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  • DOI: https://doi.org/10.1007/978-1-62703-254-4_7

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