Nutrición Hospitalaria (Feb 2004)
Hepatopatía crónica asociada a fibrosis quística: gasto energético en reposo, factores de riesgo y repercusión en la evolución de la enfermedad Chronic liver disease associated with cystic fibrosis: energy expended at rest, risk factors and impact on the disease's progress
Abstract
Introducción y objetivos: La fibrosis quística es la enfermedad recesiva más frecuente. Existen diferentes alteraciones hepatobiliares; la más importante es el desarrollo de obstrucción biliar y fibrosis periportal. El objetivo es valorar la influencia de la hepatopatía en el estado nutricional, la evolución de la enfermedad y los factores de riesgo asociados. Ámbito: Unidad de Nutrición del Servicio de Gastroenterología del Hospital Infantil La Paz. Material y métodos: Estudio longitudinal prospectivo con 53 pacientes valorados en tres momentos durante 3 años; al inicio, al año y a los 3 años. Solo 37 se siguieron los 3 años. Se realizan 111 mediciones que incluyen: análisis de la composición corporal, del gasto energético, de la ingesta y de las pérdidas energéticas así como balance nitrogenado. Simultáneamente se realizan pruebas de función respiratoria y se valora la presencia de reagudización respiratoria. Resultados: 37 pacientes, 19 mujeres y 18 varones (edad media 13,04 años ± 3,28). Doce (32,43%) fueron diagnosticados de hepatopatía (edad media 12,16 años ± 3,86 DS, 11 varones, 1 mujer) de los cuales 1 presentó íleo meconial, 5 eran homocigotos, 5 heterocigotos y los 2 restantes presentaban otras mutaciones. Los hepatópatas presentan parámetros antropométricos mejores o similares que los pacientes sin hepatopatía (p NS). Media del índice de Waterlow en hepatópatas: 93,62% ± 7,87 DS; no hepatópatas: 93,06% ± 10,97 DS (p NS). Media de FEV1 en hepatópatas: 88,81 ± 27,32 DS; no hepatópatas: 75,21 ± 27,92 DS (p Introduction and goals: Cystic fibrosis is the most frequent recessive disease. There are various hepato-biliary alterations, of which the most important is the development of biliary obstruction and periportal fibrosis. The goal is to assess the influence of liver disease on the nutritional status, the progress of the disease and the associated risk factors. Scope: Nutrition Unit of the Gastroenterology Department at La Paz Children’s Hospital. Material and methods: Prospective longitudinal study with 53 patients assessed on three occasions over 3 years: at inclusion, after 1 year and after 3 years. Only 37 of them were followed-up for 3 years. A total of 111 measurements were taken, including analysis of body composition, energy expenditure, intake and energy losses as well as nitrogen balance. Simultaneously, respiratory function tests were performed and the presence of repeated acute respiratory problems was evaluated. Results: 37 patients, 19 females and 18 males (mean age 13.04 years ± 3.28). Twelve (32.43%) were diagnosed as having liver disease (mean age 12.16% ± 3.86 SD, 11 males, 1 female), of whom 1 presented meconial ileum, 5 were homozygotic, 5 heterozygotic and the other two presented other mutations. Those with liver disease presented anthropometric parameters that were better than or similar to the patients without liver involvement (p NS). Mean Waterlow index in liver disease sufferers: 93.62% ± 7.87 SD; without liver disease: 93.06% ± 10.97 SD (p NS). Mean of LVEF in liver disease sufferers: 88.81 ± 27.32 SD; without liver disease: 75.21 ± 27.92 SD (p <0.05). Mean FVC in liver disease sufferers: 95.38 ± 22.92 SD; without liver disease: 83 ± 23.7 SD (p <0.05). Mean energy expenditure at rest/lean body mass in liver disease sufferers: 38.81 kcal ± 7.26 SD; without liver disease: 42.36 kcal ±f 6.91 SD (p < 0.05). Conclusions: The prevalence of chronic liver disease in patients with cystic fibrosis increases with age and is more frequent in males. Liver disease sufferers present a better evolution in pulmonary function and present less energy expenditure.
