Pre-operative nutritional support in children with end-stage liver disease accepted for liver transplantation: An approach to management

Authors

  • S. E. CHIN,

    1. *Department of Gastroenterology and Nutrition, Royal Children's Hospital, and University of Queensland, Brisbane, Australia
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  • R. W. SHEPHERD,

    Corresponding author
    1. †Queensland Liver Transplant Service, Royal Children's and Princess Alexandra Hospitals, and University of Queensland, Brisbane, Australia
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  • G. J. CLEGHORN,

    1. †Queensland Liver Transplant Service, Royal Children's and Princess Alexandra Hospitals, and University of Queensland, Brisbane, Australia
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  • M. PATRICK,

    1. †Queensland Liver Transplant Service, Royal Children's and Princess Alexandra Hospitals, and University of Queensland, Brisbane, Australia
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  • T. H. ONG,

    1. †Queensland Liver Transplant Service, Royal Children's and Princess Alexandra Hospitals, and University of Queensland, Brisbane, Australia
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  • J. WILCOX,

    1. *Department of Gastroenterology and Nutrition, Royal Children's Hospital, and University of Queensland, Brisbane, Australia
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  • S. LYNCH,

    1. †Queensland Liver Transplant Service, Royal Children's and Princess Alexandra Hospitals, and University of Queensland, Brisbane, Australia
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  • R. STRONG

    1. †Queensland Liver Transplant Service, Royal Children's and Princess Alexandra Hospitals, and University of Queensland, Brisbane, Australia
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R. W. Shepherd, Director of Gastroenterology and Nutrition, Royal Children's Hospital, Brisbane, Qld 4029, Australia.

Abstract

Pre-operative nutritional support was studied in 28 children with end-stage liver disease awaiting orthotopic liver transplantation. Nasogastric supplemental administration of a standard semi-elemental enteral nutritional formula was compared with a similar formula enriched with branched chain amino acids, and with a group receiving oral nutrition only. The duration of treatment in all groups was similar (mean 90 days). Energy intakes in the supplemented groups were 120–150% of recommended daily intakes (RDI), whereas ad libitum intakes in the oral group ranged 58–100% RDI. A significant improvement in mean Z-score for body weight (denoting catch-up) was noted only in those children who received nasogastric supplements enriched with branched-chain amino acids. The standard enterally-fed group maintained their body weight and Z-scores did not change significantly. In contrast, body weight Z-scores in those fed orally declined significantly. Nutritional supportive therapy of malnourished children with end-stage liver disease can minimize or improve nutritional status in children awaiting liver transplantation. The use of nutritional formulae rich in branched-chain amino acids may have nutritional advantages in children with chronic liver disease which require further study and evaluation.

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