Nutritive status peculiarities, assessment and correction in chronic liver diseases in children
Keywords:
children, chronic liver diseases, nutritive correction, malnutritionAbstract
The problem of nutrition status peculiarities, its assessment and dietetic correction in pediatric chronic liver diseases is presented in the article. Chronic liver diseases is quite a wide spread problem in both adult and pediatric gastroenterology. Providing adequate nutrition remarkably influences the course of the pathology, effectiveness of treatment and estimates the success of rehabilitation after liver transplantation. Malnutrition — multifactor nutritive insufficiency — is the most common nutritive disorder in childhood chronic liver diseases. Mechanisms of its evelopment with the detailed characteristics of proteins, carbohydrates and fats metabolism disorders are presented in the article. Methods of nutritive status assessment in pediatric patients with chronic liver diseases are given besides. The latest recommended by NASPGHAN and ESPGHAN methods of anthropometric, functional, clinical, instrumental and laboratory evaluation of the patient's nutritive status are presented. Special attention is paid to clinical signs of macro- and micronutrients deficiencies. The most important part of the article is that one devoted to the problems of dietetic correction of chronic liver diseases in childhood. Diet therapy is save method of treatment which is of no less importance than drug treatment as far as quantitatively and qualitatively balanced diet helps to achieve stabilization of pathological process and prevent its progression in a huge number of patients with chronic liver diseases. The problem of increased energetic needs in children with chronic liver diseases as well as methods of providing these needs by using hypercaloric formulas and hypercaloric drinks is reflected in the article. Special attention is attracted to the problems of quantitative and qualitative provision of patients with proteins. For years scientific society could not answer the question of quantitative needs of chronic liver diseases patients in proteins in connection with often development of hepatic encephalopathy in these patients and necessity of branched amino acids use. The article presents new data based on the latest researches and Cochrane analysis which finally give answers on those questions. As far as proper providing the part of carbohydrates in the ration is not less important the article describes its peculiarities including the necessity of using formulas containing maltodextrin and glucose polymers, peculiarities of carbohydrates consumption in children with steatohepatosis and carbohydrates metabolism disorders and specificity of using fibers and lactulose. While reflecting the problem of fats consumption a special attention is paid to the necessity of mid chain tryglicerids use effectiveness. In the final part of the article algorithm of nutrition organization in children with chronic liver diseases is given.
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