Z Gastroenterol 2010; 48(7): 763-770
DOI: 10.1055/s-0029-1245388
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Proteinkatabolie und Mangelernährung bei Leberzirrhose – Möglichkeiten der oralen Ernährungstherapie

Protein Catabolism and Malnutrition in Liver Cirrhosis – Impact of Oral Nutritional TherapyK. Norman1 , L. Valentini1 , H. Lochs1 , M. Pirlich1
  • 1Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Charité – Universitätsmedizin Berlin
Further Information

Publication History

Manuskript eingetroffen: 3.12.2009

Manuskript akzeptiert: 6.4.2010

Publication Date:
06 July 2010 (online)

Zusammenfassung

Mangelernährung mit Muskelmassenverlust findet sich häufig bei Patienten mit Leberzirrhose mit negativen Folgen für Morbidität und Mortalität. Die Ätiologie der Mangelernährung ist multikausal und schließt chronische Entzündungsreaktionen, frühzeitiges Einsetzen der Glukoneogenese durch verringerte Glykogenspeicher sowie bei einem Teil der Patienten auch einen erhöhten Energieumsatz ein. Die verringerte Nahrungsaufnahme spielt jedoch per se die wichtigste Rolle in der Pathogenese der Mangelernährung bei Leberzirrhose. Es gibt vielfältige Hinweise, dass die Nahrungsaufnahme und die Ernährungstherapie bei Leberzirrhose oft unzureichend sind, obwohl mehrere Studien eindrücklich zeigen, dass die Nahrungsaufnahme durch professionelle Ernährungsberatung und ergänzende Trinknahrungen verbessert werden kann. Der Proteinbedarf gilt bei Lebererkrankungen als erhöht und es ist vielfach gezeigt worden, dass eine hohe Proteinzufuhr gut verträglich ist und mit einer Verbesserung des Ernährungszustands und der Leberfunktion einhergeht. Eine Proteinintoleranz ist hingegen selten und die hepatische Enzephalopathie kann nur in den seltensten Fällen auf eine erhöhte Proteinzufuhr zurückgeführt werden. Eine generelle Proteinrestriktion gilt daher als obsolet und muss vielmehr als Risikofaktor für einen ungünstigen klinischen Verlauf angesehen werden. Mehrere Studien haben außerdem gezeigt, dass die Einnahme einer Spätmahlzeit von Vorteil ist, da dadurch die verfrüht auftretende Übernachtnüchternphase verkürzt wird. Die Supplementierung mit verzweigtkettigen Aminosäuren, deren Konzentration bei Leberzirrhose verringert ist, hat außerdem noch einen positiven Einfluss auf die Lebensqualität und verlängert die komplikationsfreie Überlebenszeit.

Abstract

Malnutrition with loss of muscle is common in patients with liver cirrhosis and has negative impact on morbidity and mortality. The aetiology of malnutrition is multifactorial and includes inflammation, early onset of gluconeogenesis due to impaired glycogen storage and sometimes hypermetabolism. Reduced nutritional intake, however, plays the most important role in the pathogenesis of malnutrition. There is, however, ample evidence that nutritional intake and therapy are inadequate in liver cirrhosis although studies have clearly shown that dietary counselling and nutritional therapy with oral supplements improve intake in these patients. Protein requirement is considered to be increased in liver cirrhosis and high protein intake has been shown to be well tolerated and associated with an improvement of liver function and nutritional status. Protein intolerance on the other hand is uncommon and hepatic encephalopathy can thus rarely be attributed to high protein consumption. Recommendations for general protein restriction must therefore be considered obsolete and rather a risk factor for an impaired clinical outcome. Furthermore, the administration of late evening meals is highly beneficial in patients with liver disease since the rapid onset of the overnight catabolic state is counteracted. The serum concentration of branched-chain amino acids (BCAA) is decreased in patients with liver cirrhosis and long-term supplementation of BCAA has been shown to improve nutritional status and prolong event-free survival and quality of life.

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Dr. Kristina Norman

Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Charité – Universitätsmedizin Berlin

Campus Mitte

10098 Berlin

Phone: ++ 49/30/4 50 51 41 39

Fax: ++ 49/30/4 50 51 49 36

Email: kristina.norman@charite.de

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