代谢功能障碍相关脂肪变性肝病相关肝硬化患者营养指标的早期改变

IF 2.6 Q3 NUTRITION & DIETETICS

Clinical nutrition ESPEN Pub Date : 2025-07-16 DOI:10.1016/j.clnesp.2025.07.029

Teruki Miyake , Shinya Furukawa , Osamu Yoshida , Ayumi Kanamoto , Yoshimasa Murakami , Masumi Miyazaki , Makoto Morita , Sho Ishikawa , Yuki Numata , Hironobu Nakaguchi , Yoshiko Nakamura , Mitsuhito Koizumi , Takao Watanabe , Yasunori Yamamoto , Yoshio Tokumoto , Masashi Hirooka , Hirohito Mori , Eiji Takeshita , Teru Kumagi , Yoshio Ikeda , Yoichi Hiasa

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引用次数: 0

摘要

背景和目的：代谢功能障碍相关的脂肪变性肝病（MASLD）主要由相对营养过剩引起。饮食限制和通过运动减肥可以改善这种情况。然而，随着MASLD的进展，需要足够的营养摄入来预防失代偿性肝硬化。因此，需要适当的营养评估工具来指导从饮食限制到充足营养摄入的过渡。然而，MASLD营养不良的早期风险指标，特别是失代偿性肝硬化发展之前，仍不清楚。本研究旨在探讨肝硬化MASLD患者恶化的营养指标。方法：本横断面研究纳入了2007年10月至2024年6月在爱媛大学医院通过肝活检诊断为MASLD的154例患者（18-79岁），并在住院期间接受了营养评估。结果：皇家自由医院营养优先排序工具将所有患者分类为低风险。多因素分析，调整年龄、性别、体重指数、肌酐水平和非酒精性脂肪肝疾病活动度评分，确定较低的白蛋白、较低的胆碱酯酶、较高的血红蛋白A1c、较低的总胆固醇和较低的低密度（LDL）胆固醇与晚期纤维化独立相关。然而，在身体组成、营养摄入和非蛋白质呼吸商方面没有观察到显著差异。结论：反映蛋白质合成的血液指标，包括白蛋白和胆碱酯酶，是了解masld相关性肝硬化患者营养状况变化的有用指标。临床医生在针对masld相关肝硬化及时改变营养干预措施时应考虑这些指标。

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Early alterations in nutritional indices in metabolic dysfunction-associated steatotic liver disease-related cirrhosis

Background and aim

Metabolic dysfunction-associated steatotic liver disease (MASLD) is primarily driven by relative overnutrition. Dietary restrictions and weight loss through exercise are known to improve this condition. However, as MASLD progresses, adequate nutritional intake is required to prevent decompensated cirrhosis. Therefore, appropriate nutritional assessment tools are needed to guide the transition from dietary restriction to adequate nutritional intake. However, early risk indicators of malnutrition in MASLD, particularly before decompensated cirrhosis develops, remain unclear. This study aimed to explore nutritional markers indicative of deterioration in MASLD with cirrhosis.

Methods

This cross-sectional study included 154 patients (aged 18–79 years) diagnosed with MASLD by liver biopsy between October 2007 and June 2024 at Ehime University Hospital and received nutritional assessments during hospitalization.

Results

The Royal Free Hospital Nutritional Prioritizing Tool classified all patients as low risk. Multivariate analysis, adjusted for age, sex, body mass index, creatinine levels, and nonalcoholic fatty liver disease activity score, identified lower albumin, lower cholinesterase, higher hemoglobin A1c, lower total cholesterol, and lower low-density (LDL) cholesterol as independently associated with advanced fibrosis. However, no significant differences were observed in body composition, nutritional intake, and non-protein respiratory quotients.

Conclusions

Blood indices reflecting protein syntheses, including albumin and cholinesterase, were useful makers for comprehending the change in nutritional status in MASLD-related cirrhosis. Clinicians should consider these markers when initiating timely changes in nutritional interventions for MASLD-related cirrhosis.

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来源期刊

Clinical nutrition ESPEN NUTRITION & DIETETICS-

CiteScore

4.90

自引率

3.30%

发文量

512

期刊介绍： Clinical Nutrition ESPEN is an electronic-only journal and is an official publication of the European Society for Clinical Nutrition and Metabolism (ESPEN). Nutrition and nutritional care have gained wide clinical and scientific interest during the past decades. The increasing knowledge of metabolic disturbances and nutritional assessment in chronic and acute diseases has stimulated rapid advances in design, development and clinical application of nutritional support. The aims of ESPEN are to encourage the rapid diffusion of knowledge and its application in the field of clinical nutrition and metabolism. Published bimonthly, Clinical Nutrition ESPEN focuses on publishing articles on the relationship between nutrition and disease in the setting of basic science and clinical practice. Clinical Nutrition ESPEN is available to all members of ESPEN and to all subscribers of Clinical Nutrition.