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Changes in nutritional status after liver transplantation

World Journal of Gastroenterology 2014年第31期20卷 10682-10690页

作者： Michela Giusto Barbara Lattanzi vincenza di gregorio Valerio Giannelli Cristina Lucidi Manuela Merli Ⅱ Gastroenterologia Dipartimento di Medicina Clinica "Sapienza" Università di Roma00185 Roma Italy

Chronic liver disease has an important effect on nutritional status, and malnourishment is almost universally present in patients with end-stage liver disease who undergo liver transplantation. During recent decades,a trend has been reported that shows an increase in number of patients with end-stage liver disease and obesity in developed countries. The importance of carefully assessing the nutritional status during the workup of patients who are candidates for liver replacement is widely recognised. Cirrhotic patients with depleted lean body mass(sarcopenia) and fat deposits have an increased surgical risk; malnutrition may further impact morbidity, mortality and costs in the post-transplantation setting. After transplantation and liver function is restored, many metabolic alterations are corrected,dietary intake is progressively normalised, and lifestyle changes may improve physical activity. Few studies have examined the modifications in body composition that occur in liver recipients. During the first 12 mo, the fat mass progressively increases in those patients who had previously depleted body mass, and the muscle mass recovery is subtle and non-significant by the end of the first year. In some patients, unregulated weight gain may lead to obesity and may promote metabolicdisorders in the long term. Careful monitoring of nutritional changes will help identify the patients who are at risk for malnutrition or over-weight after liver transplantation. Physical and nutritional interventions must be investigated to evaluate their potential beneficial effect on body composition and muscle function after liver transplantation.

关键词： Liver transplantation Sarcopenia Malnutrition Obesity Metabolic syndrome Outcome Survival

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Microbiota and the gut-liver axis:Bacterial translocation,inflammation and infection in cirrhosis

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World Journal of Gastroenterology 2014年第45期20卷 16795-16810页

作者： Valerio Giannelli vincenza di gregorio Valerio Iebba Michela Giusto Serena Schippa Manuela Merli Ulrich Thalheimer Gastroenterology Department of Clinical Medicine Sapienza University of Rome Department of Public Health and Infectious diseases Sapienza University of Rome The Exeter Liver Unit Royal Devon and Exeter Foundation Trust

Liver disease is associated with qualitative and quantitative changes in the intestinal microbiota. In cirrhotic patients the alteration in gut microbiota is characterized by an overgrowth of potentially pathogenic bacteria (i.e., gram negative species) and a decrease in autochthonous familiae. Here we summarize the available literature on the risk of gut dysbiosis in liver cirrhosis and its clinical consequences. We therefore described the features of the complex interaction between gut microbiota and cirrhotic host, the so called “gut-liver axis”, with a particular attention to the acquired risk of bacterial translocation, systemic inflammation and the relationship with systemic infections in the cirrhotic patient. Such knowledge might help to develop novel and innovative strategies for the prevention and therapy of gut dysbiosis and its complication in liver cirrhosis.

关键词： Dysbiosis Cirrhosis Bacterial translocation Inflammation Infection Bacterial overgrowth Rifaximine Lactulose Liver Gut Portal hypertension

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