The importance of sarcopenia and frailty in the management of cirrhosis

2021 ◽  
Vol 75 (2) ◽  
pp. 102-109
Author(s):  
Petra Vrbová ◽  
Tomáš Koller
Keyword(s):  
Liver Transplantation ◽  
Functional Status ◽  
Early Identification ◽  
Nutritional Support ◽  
Patient Management ◽  
Daily Activities ◽  
Disease Stage ◽  
Practical Reasons ◽  
Risk Of Falls

At present, we have enough tools for quick and accurate assessment of the muscle strength and functional status of a patient with cirrhosis. In recent years, the diagnostic criteria for sarcopenia and frailty are gradually merging into one, primarily for practical reasons. Both of them are equally negative predictors of disease development in hospitalized patients with cirrhosis regardless of the decision on the indication of liver transplantation, but also in patients on the waiting list, and in those after liver transplantation. Sarcopenia and frailty are strong and disease stage-independent predictors of mortality. Undiagnosed and untreated sarcopenia or frailty also increase the risk of falls and fractures, impair the natural ability to perform daily activities, and increase the degree of dependence on others. They are associated with a reduced cognitive function, higher risk of complications, reduced quality of life and prolonged hospitalization. Their early identification will enable the optimization of patient management with the immediate use of nutritional support and pre-habilitation in order to prevent further deterioration of functional status and avoid adverse consequences of the disease.

scholarly journals SHORT-TERM EFFECT OF WHEY PROTEIN SUPPLEMENTATION ON THE QUALITY OF LIFE OF PATIENTS WAITING FOR LIVER TRANSPLANTATION: A DOUBLE BLINDED RANDOMIZED CLINICAL TRIAL

2021 ◽  
Vol 34 (2) ◽  
Author(s):  
Michelle Carvalho de Oliveira D’ALESSANDRO ◽  
Amanda Dias GOMES ◽  
Jéssica França MORAIS ◽  
Yani Glaúcia Gomide MIZUBUTI ◽  
Thales Antônio da SILVA ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Trial ◽  
Liver Transplantation ◽  
Liver Disease ◽  
Functional Status ◽  
Whey Protein ◽  
Protein Supplementation ◽  
Term Effect ◽  
Short Term

ABSTRACT Background: Chronic liver disease is associated with malnutrition that negatively impacts a patient’s health-related quality of life (HRQoL). Aim: To evaluate the short-term effect of whey protein supplementation on the HRQoL and nutritional and functional status of patients waiting for liver transplantation. Methods: This was a double-blind randomized clinical trial with patients waiting for liver transplantation who were randomized into two groups: WP (whey protein supplementation) and the control (casein supplementation). Both groups received 40 g (20 g in the morning and 20 g in the evening) for 15 days. Nutritional and functional status were evaluated. Energy balance was calculated as the difference between energy intake (24-hour recall) and total energy expenditure (assessed by indirect calorimetry). The chronic liver disease questionnaire was used to assess HRQoL. All measurements were performed before and after the intervention. Results: Fifty-six patients were evaluated. Malnutrition was present in 56.9%, and it was directly associated with a poor HRQoL (p<0.05). No improvement on the nutritional and functional status was observed, in either group after protein supplementation. HRQoL improved after WP and casein supplementation, with no differences between groups (p>0.05). Patients who met protein requirements and had a positive energy balance demonstrated a higher HRQoL score (4.9, p<0.05), without between-group differences. Conclusion: Malnutrition substantially reduces HRQoL. Short-term WP or casein supplementation improved similarly the HRQoL.

scholarly journals SHORT-TERM EFFECT OF WHEY PROTEIN SUPPLEMENTATION ON THE NUTRITIONAL STATUS AND QUALITY OF LIFE OF PATIENTS WAITING FOR LIVER TRANSPLANTATION

2020 ◽  
Author(s):  
Michelle d’Alessandro ◽  
Jéssica Morais ◽  
Yani Mizubuti ◽  
Thales da Silva ◽  
Silvia Fernandes ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Liver Transplantation ◽  
Liver Disease ◽  
Functional Status ◽  
Chronic Liver Disease ◽  
Whey Protein ◽  
Protein Supplementation ◽  
Term Effect ◽  
Short Term

Background & aims: Chronic liver disease is associated with malnutrition that negatively impacts a patient’s health-related quality of life (HRQoL). We evaluated the short-term effect of whey protein supplementation on the HRQoL and nutritional and functional status of patients waiting for liver transplantation (LT). Methods: This was a double-blind randomized clinical trial with patients waiting for LT who were randomized into two groups: WP (whey protein supplementation) and the control (casein supplementation). Both groups received 40g (20g in the morning and 20 g in the evening) for 15 days. Nutritional and functional status were evaluated. Energy balance (EB) was calculated as the difference between energy intake (24-hour recall) and total energy expenditure. The chronic liver disease questionnaire (CLDQ) was used to assess HRQoL. All measurements were performed before and after the intervention. Results: Fifty-six patients were evaluated. Malnutrition was present in 56.9% of patients, and it was directly associated with a poor HRQoL (p<0.05). No improvement on the nutritional and functional status was observed, in either group after protein supplementation. HRQoL improved after WP and casein supplementation, with no differences between groups (p>0.05). Patients who met protein requirements and had a positive EB demonstrated a higher HRQoL score (4.9) (p<0.05), without between-group differences. Conclusion: Malnutrition substantially reduces HRQoL. Short-term WP or casein supplementation improved the HRQoL.

scholarly journals Effects of comprehensive and intensive pulmonary rehabilitation and nutritional support on quality of life and functional status in patients with chronic obstructive pulmonary disease

2020 ◽  
Vol 48 (4) ◽  
pp. 030006052091956
Author(s):  
Celalettin Korkmaz ◽  
Soner Demirbas ◽  
Hulya Vatansev ◽  
Elif Yildirim ◽  
Turgut Teke ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Chronic Obstructive Pulmonary Disease ◽  
Body Composition ◽  
Functional Status ◽  
Pulmonary Disease ◽  
Pulmonary Rehabilitation ◽  
Nutritional Support ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease

Objective To investigate the effects of pulmonary rehabilitation (PR) and combined nutritional support therapy on quality of life (QoL) and functional status in patients with chronic obstructive pulmonary disease (COPD). Methods This pre-and post-intervention prospective exploratory study involved 64 patients with stable stage three to four COPD. Oral nutritional support and personalized diet were combined with an intense and comprehensive PR program. Baseline and 8-week follow-up scores were compared for the 6-minute walk test (6MWT), incremental shuttle walking test (ISWT), St. George’s Respiratory Questionnaire (SGRQ), pulmonary function tests (PFT), PImax-PEmax, arterial blood gas (ABG), respiratory rate (RR), handgrip strength, Borg and modified Medical Research Council dyspnoea scale scores and fat-free mass index. Results Significant improvements were found in functional status (6MWT: 86.72 m, ISWT: 76.24 m), QoL (SGRQ total: 13.86), PFT, ABG, RR, dyspnoea, upper extremity muscle strength and hand-body composition. Conclusion Nutritional support with comprehensive and intensive PR can significantly improve physical performance, QoL, dyspnoea and body composition in COPD. The improvement in QoL was greater than that reported in previous studies. Because two modalities were combined in this study, future randomized controlled studies are needed to confirm the extent and contribution of these modalities to the outcomes.

Health-Related Quality of Life in Patients with Ankylosing Spondylitis: Relationship with Disease-Related Variables

2020 ◽  
Vol 16 (4) ◽  
pp. 311-318 ◽  
Author(s):  
Gehan Elolemy ◽  
Ahmed Aboughanima ◽  
Sahar Ganeb ◽  
Haytham Elziat
Keyword(s):  
Quality Of Life ◽  
Ankylosing Spondylitis ◽  
Physical Health ◽  
Disease Activity ◽  
Functional Status ◽  
Spinal Mobility ◽  
Peripheral Arthritis ◽  
Radiographic Severity ◽  
Sf 36

Background: Ankylosing spondylitis (AS) is a chronic progressive inflammatory disease leading to functional limitations and subsequently impaired quality of life (QoL). Despite the fact that QoL was recognized as a significant perception, it was excluded from the core domains (defined by the Assessment of Spondyloarthritis International Society), because of ambiguity of measurement choice. Aim: To assess QoL in patients with AS using a generic; Short Form-36 (SF-36) and a diseasespecific; Ankylosing Spondylitis quality of life (ASQoL) instruments and to explore its relationship to the clinical characteristics, disease activity, functional status, and radiographic severity. Methods: A total of 47 AS patients who fulfilled modified New York criteria were included. Disease activity, functional status, spinal mobility, and radiographic severity were assessed by Bath AS Disease Activity Index (BASDAI), Bath AS Functional Index (BASFI), Bath AS Metrology Index (BASMI) and Bath AS Radiology Index (BASRI) respectively. SF-36 and ASQoL instruments evaluated Qol. Results: Physical health was more affected especially in patients with peripheral arthritis by SF-36 (p=0.008) and ASQoL (p=0.022) scores. Both SF-36 total and ASQoL scores correlated significantly with BASDAI (r = -0.329, p = 0.024 and r = 0.420, p = 0.003), BASFI (r = -0.399, p = 0.005 and r = 0.513, p=0.001) and BASMI (r = -0.382, p = 0.008 and r = 0.482, p= 0.001) respectively. Conclusion: QoL was impaired in AS patients with highest impact on physical health especially in association with peripheral arthritis. SF-36 and ASQol have a comparable achievement in the evaluation of QoL in AS patients and both physical function and spinal mobility were identified as predictors of poor QoL.

scholarly journals Palliative care and complex chronic conditions since the perspective of healthcare professionals

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Doñate-Martínez ◽  
L Llop ◽  
J Garcés
Keyword(s):  
Primary Care ◽  
Palliative Care ◽  
Early Identification ◽  
Chronic Conditions ◽  
Healthcare Professionals ◽  
Care Pathway ◽  
Holistic View ◽  
Complex Chronic Conditions ◽  
Symptom Intensity

Abstract Background According to the WHO, palliative care (PC) is applicable early in the course of illness together with other curative therapies. Early PC has demonstrated beneficial effects on quality of life and symptom intensity among cancer patients. However, PC is not as early integrated on the care pathway of complex chronic conditions (CCC). This abstract presents barriers and needs identified to effectively implement early PC on CCC performed under the EU-funded InAdvance project (ref.: 825750). Methods Semi-structured interviews were performed with 16 healthcare professionals (HPs) from primary care and hospital settings working with older patients with CCC in Valencia (Spain). Results Interviews reported that main needs identified to provide early PC are: (a) coordinated strategies between multi-setting HPs to an early identification of CCC patients in need of PC; (b) adequate resources to attend patients' PC needs from a holistic view, i.e. psychosocial and spiritual needs; and (c) early integration of basic PC at primary care teams. The main barriers identified were: (a) stereotypes associated to the traditional PC approach; (b) poor knowledge from HPs of the PC holistic approach; and (c) lack of specific protocols or pathways for CCC in need of PC. Conclusions Specific skills and resources are the most relevant needs to effectively provide early PC among patients with CCC. First, it is urgent to demystify the negative culture-related vision of PC that is commonly associated to sedation and last days of a person's life. Also, multidisciplinary HPs require specific training to identify and provide early PC tailored to CCC. And, it is required a strategic and multi-setting organizational approach with fluent information flow and coordinated roles. Key messages Healthcare expenditure would be considerably reduced, especially at hospital and emergency units, with an early identification of patients with CCC in need of PC. Empowering primary HPs in PC would improve the quality of care of patients with CCC.

Sign in / Sign up

Export Citation Format

Share Document