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Die Gastroenterologie
Erschienen in: Die Gastroenterologie 4/2023

16.06.2023 | Leberzirrhose | Schwerpunkt

Ernährung bei fortgeschrittener Leberzirrhose und perioperativ bei Lebertransplantation

verfasst von: PD Dr. med. Nina Weiler, Jörg Bojunga

Erschienen in: Die Gastroenterologie | Ausgabe 4/2023

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Zusammenfassung

Die Leberzirrhose führt durch verschiedene Mechanismen zu einer Mangelernährung als schwerwiegende Komplikation. Mangelernährung tritt in bis zu über 50 % bei dekompensierter Leberzirrhose auf und erhöht das Risiko für andere Komplikationen wie Aszites, Blutung oder hepatische Enzephalopathie deutlich. Häufig wird eine Mangelernährung jedoch nicht diagnostiziert oder nicht ausreichend behandelt. Mangelernährung geht oftmals mit einer Reduktion der Muskelmasse, einer Sarkopenie, einher. Bei gleichzeitig bestehender Adipositas kommt es zu einer sarkopenen Adipositas. Der Body-Mass-Index ist kein hinreichendes Kriterium zur Beurteilung des Ernährungsstatus. Neben einer detaillierten Anamnese sollten eine Messung der Muskelmasse, z. B. mithilfe des Oberarmumfangs, der Bioimpedanzanalyse oder der Bauchwandmuskulatur in der Computertomographie (CT) oder Magnetresonanztomographie (MRT), der Handkraft und der Ganggeschwindigkeit erfolgen. Zur Beurteilung der Gebrechlichkeit bei Leberzirrhose kann der Liver Frailty Index eingesetzt werden. Maßnahmen zur Therapie umfassen eiweißreiche und hochkalorische Ernährung, einschließlich einer Spätmahlzeit. Lange Nüchternzeiten sollten vermieden werden. Zudem wird eine moderate Bewegung empfohlen. Zu beachten ist, dass körperliche Aktivität den Pfortaderdruck steigern kann. Mangelernährung und Sarkopenie bei Patienten auf der Warteliste zur Lebertransplantation sind mit erhöhter Mortalität vor und nach Transplantation assoziiert. Der Nutzen einer strukturierten präoperativen Prähabilitation im Hinblick auf perioperative Komplikationen und das Überleben ist noch nicht belegt, dennoch wird eine moderate körperliche Aktivität vor Transplantation angestrebt, da sich auch Alltagstätigkeiten günstig auf das perioperative Überleben auswirken können.
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Metadaten
Titel
Ernährung bei fortgeschrittener Leberzirrhose und perioperativ bei Lebertransplantation
verfasst von
PD Dr. med. Nina Weiler
Jörg Bojunga
Publikationsdatum
16.06.2023

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