ABSTRACT
Objective: the aim of our study was to examine, in a prospec-
tive way, whether any nutritional parameter could predict out-
comes after liver transplantation.
Material and subjects: a nutritional assessment was per-
formed in 31 consecutive patients six months prior to undergoing
orthotopic liver transplantation (OLT) at a single center (Hospital
U. Río Hortega) and after six months of OLT (December 2002-
June 2004). The nutritional evaluation included Subjective Global
Assessment (SGA), Mini Nutritional Assessment test (MNA), an-
thropometry, laboratory tests, and three-day diet diary completed.
The body composition analysis was performed by tetrapolar body
electrical bioimpedance and skin folds in a standard way.
Results: our patients had an average age of 56.2 ± 8.11
years; weight was 72.9 ± 15.3 kg, and body mass index was 26.6
± 4.1. The anthropometric evaluation showed the following data:
tricipital skin fold 12.2 ± 6.1 mm, mid-arm circumference 24.5 ±
4.1 cm, fat-free mass 54.5 ± 10.9 kg, fat mass 18.4 ± 6.5 mm,
and body water 41.4 ± 9.1 kg. After six months from liver trans-
plantation, these parameters remained unchanged. Energy intake,
as corrected by weight, was similar pre- and post-liver transplanta-
tion (28.1 ± 6 kcal/kg vs. 27.5 ± 5.8 kcal/kg: ns). Albumin, pre-
albumin and transferrin improved after 6 months from transplan-
tation. Length of stay in hospital was 22.4 ± 14.9 days, and
length of stay in ICU was 0.7 ± 1.7 days. The nutritional status
(SGA and MNA tests) of patients did not influence length of stay
in either hospital or ICU. No intercurrent events (infections: uri-
nary tract infection, pneumonia, and peritonitis) were recorded
during the 6-month study period. Two patients died after liver
transplantation (6.5%), and 3 patients had acute rejection (9.6%).
Patients with malnutrition (SGA and MNA tests classification)
showed no differences in rejection and mortality.
Conclusions: our liver transplantation population had normal
nutritional status and dietary intake. Nutritional parameters
showed no association with outcomes after liver transplantation.
Liver transplantation improved serum protein levels and did not
modify weight or dietary intake. Further studies are needed to
clarify the role of liver transplantation on nutritional status and of
nutritional status on liver transplantation outcomes, considering
different populations of patients.
Key words: Dietary intake. Liver transplantation. Nutritional sta-
tus.
De Luis DA, Izaola O, Velicia MC, Sánchez Antolín G, García
Pajares F, Terroba MC, Cuéllar L. Impact of dietary intake and
nutritional status on outcomes after liver transplantation. Rev
Esp Enferm Dig 2006; 98: 6-13.
INTRODUCTION
Chronic liver disease may be associated with malnutri-
tion (1), the severity of which ranges from subclinical
status to overt energy-protein malnutrition. In patients
with decompensated cirrhosis, protein-energetic malnu-
trition is universal with low dietary intakes (2).
The presence of energy-protein malnutrition has been
associated with increased morbidity and mortality in pa-
tients undergoing liver transplantation (3,4). Preoperative
malnutrition has been reported to be associated with
length of stay in intensive care units (4) and mortality (5).
Screening for malnutrition has been proposed as a part of
liver transplantation protocols.
Developing such a strategy has been unclear due to the
heterogeneity of methods to assess nutritional status.
Much of the difficulty in identifying an optimal method
for nutritional assessment in patients with cirrhosis arises
from the fact that many of the traditionally measured pa-
rameters of nutritional status vary with severity of liver
disease.
The aim of our study was to examine, in a prospective
way, whether some nutritional parameters could predict
clinical parameters after liver transplantation.
Impact of dietary intake and nutritional status on outcomes after
liver transplantation
D. A. de Luis
1
, O. Izaola
1
, M. C. Velicia
1,2
, G. Sánchez Antolín
1,2
, F. García Pajares
1,2
, M. C. Terroba
1
and
L. Cuéllar
1
1
Section of Endocrinology and Nutrition. Instituto de Endocrinología y Nutrición (IEN). School of Medicine.
2
Service of
Digestive Diseases. Hospital Universitario Río Hortega. Valladolid, Spain
1130-0108/2006/98/1/6-13
REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS
Copyright © 2006 ARÁN EDICIONES, S. L.
REV ESP ENFERM DIG (Madrid)
Vol. 98. N.° 1, pp. 6-13, 2006
Recibido: 27-05-05.
Aceptado: 06-09-05.
Correspondencia: Daniel de Luis Román. Profesor Asociado de Endocri-
nología y Nutrición. Director Ejecutivo IEN. C/ Los Perales, 16. 47130 Va-
lladolid. e-mail: dadluis@yahoo.com
ORIGINAL PAPERS