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Correction: Hammad, a.; kaido, t.; aliyev v.; mandato c.; uemoto s. nutritional therapy in liver transplantation (Nutrients, (2017) 9, E1126)
No full textThe last paragraph on p. 13 and the first one 14: “After liver transplant, patients will have to take immunosuppressant medication to the end of their lives. Although modern drugs with less side effects are available, increased survival rates and decreased overall complications have led to many nutrition status implications associated with the use of cyclosporine, tacrolimus and corticosteroids. New onset diabetes or glucose impairment is common initially after the operation as the consequence of immunosuppressant regiment [105,106]. Diabetic dietary advice is usual required, and if necessary, the use of oral hypoglycemic or insulin regimens should be tethered according to the progression of diet. If hyperglycemia persists, it should be managed by reducing excess glucose intake, since higher insulin might hamper increased glucose oxidation in this period. Also, the diabetogenic potential of the immunosuppressant tacrolimus may be lowered by reducing its dose, without undue risk of rejection [109]. Many patients may concomitantly present with high potassium levels shortly after the operation. This usually results from the nephrotoxicity of the prescribed immunosuppressant medication. Thus, in the early post-transplant periods, it might be important to control potassium food sources as well via the recommendation of the use of dietary techniques that are able to reduce its content in nutrients [106]. In the long term, this is not indicated, as this condition mostly disappears. Hypomagnesemia also rises as a consequence of immunosuppression and, patients generally receive magnesium supplementation, however, some progress with diarrhea. The intake of magnesium rich food sources should be encouraged, such as dark cocoa, whole grains, nuts, legumes, fruits and green vegetables. Important to point that the consumption of this kind of food should not be restricted, even considering the immunocompromised host as a result of anti-graft rejection drugs. Patients should receive food safety advice to prevent foodborne infections, which can be achieved with the correct handling of fruits and vegetables [95]”. These two paragraphs are corrected to read: “After liver transplant, patients will need immunosuppressive medications for lifetime. Although new drugs with less side effects are available, increased survival rates and decreased overall complications have caused multiple nutritional implications linked to the use of cyclosporine, tacrolimus or corticosteroids [110]. New onset diabetes mellitus or glucose intolerance is not uncommon short after the operation as the consequence of immunosuppressant treatment [105,106,110]. Diabetic dietary recommendation is usually needed, and if required, the use of oral hypoglycemic or insulin treatments should be tailored according to the advancement of diet. If hyperglycemia remains, it should be addressed by decreasing glucose intake, since higher insulin might prevent increased glucose oxidation during this period. Also, the possible diabetogenic effect of tacrolimus may be decreased by decreasing its dose, without added risk of rejection [109,110]. Many patients may concurrently have high potassium levels shortly after transplant [110]. This is usually due to the nephrotoxicity of the used immunosuppressive drug. So, it might be crucial to adjust potassium food sources during the early post-operative period, and use of dietary modifications which would decrease its content in nutritional intake [106,110]. This is not required long-term after transplant, as this transient imbalance often disappears. Hypomagnesemia also occurs due to immunosuppressants and, patients usually have magnesium supplements, however, some will have diarrhea. Magnesium-rich food intake should be carried on, such as dark cocoa, whole grains, nuts, legumes, fruits and green vegetables [110]. It is crucial to mention that consumption of such kind of food should not be restricted, even considering the immunocompromised host as a result of anti-graft rejection drugs. Patients should receive dietary safety recommendations to avoid food borne infections, with the correct handling of fruits and vegetables [95,110]. The first paragraph in Section 3.3 on p. 16: “In the long-term after liver transplantation, weight gain is mostly observed. It is important to recover the nutritional status, since the patients lose an average of 9.1 kg during the course of liver disease [117]. Greatest relative weight gain occurs in the first six months after the operation [47] and, recovery of all weight loss happens in the first post-transplant year [124]. However, unfortunately, patients do not stop gaining weight in the subsequent years [125], resulting in the alarming prevalence of overweight and obesity [47]. During the first 12 months, the fat mass progressively increases in those patients who had previously depleted overall body mass, but muscle mass recovery is subtle and nonsignificant by the end of the first year [126]. Therefore, despite the weight gain, the high prevalence of sarcopenia does not change after transplantation [7,47].” This paragraph has been changed to “Weight gain is generally seen long-term after liver transplantation [110]. It is a priority to recover the nutritional status, since the patients lose an average of 9.1 kg during the course of liver disease [110,119]. Largest relative weight gain occurs in the first 6 post-operative months [47,110] and, recovery of all weight loss happens within the first post-transplant year [110,125,126]. However, patients do not stop gaining weight in the subsequent years [110,127], resulting in overweight and obesity high prevalence [47]. During the first year, the fat mass progressively increases in those patients who had previously depleted overall body mass, but muscle mass recovery occurs at a relatively lower rate by the end of the first 12 months [128]. Hence, despite the ongoing weight gain, the high prevalence of sarcopenia does not decrease after LT [7,47,110].” The authors apologize for any inconvenience caused to the readers of Nutrients by these changes. The changes do not affect the scientific results. The original manuscript will be updated and will remain online on the article webpage, with a reference to this correction
More on current evidences on probiotics as a novel treatment for non-alcoholic Fatty liver disease
No full textCholestatic jaundice in infancy: Struggling with many old and new phenotypes
No full textBackground: Clinical diagnosis of neonatal cholestasis is considered to be an extremely challenging process. Here we highlight the importance not only of the prompt distinction between extrahepatic and intrahepatic cholestasis forms, but also of the precise identification of the latter ones amongst the hotchpotch of recently discovered metabolic/genetic causes. Biliary atresia is considered a surgical emergency in a newborn infant. The rate of success in establishing the bile drainage is in fact a function of the early age when the hepato-portoenterostomy intervention is performed. Intrahepatic cholestasis is due to a broad and more and more puzzling variety of infectious, endocrine, genetic, metabolic and toxic disorders where Gamma-glutamyl transpeptidase serum levels may help for differential diagnosis. Recently established laboratory diagnostic techniques have allowed to discover new causes of neonatal cholestasis. Aim of the Commentary is to go through some of them and bring the focus particularly on the information deriving from the paper by Pinon et al. in this issue of the Journal, which paves the way to the inclusion of the hepatocyte nuclear factor-1-beta deficiency as a new condition to consider in the diagnostic process of the syndromic forms with paucity of intralobular bile ducts. Conclusion: Neonatal cholestasis poses diagnostic challenges in practice. Recent advances in the pathophysiology and in molecular genetics together with clinical features, histopathologic findings and careful reasoning remains paramount to put together the pieces of the jigsaw
Frailty in children with chronic liver disease: Growing evidence for an underexplored topic
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Congenital defects of glycosylation may underlie cryptogenic hepatopathy in asymptomatic children
No full textNutritional therapy in liver transplantation
No full textProtein-energy malnourishment is commonly encountered in patients with end-stage liver disease who undergo liver transplantation. Malnutrition may further increase morbidity, mortality and costs in the post-transplantation setting. The importance of carefully assessing the nutritional status during the work-up of patients who are candidates for liver replacement is widely recognized. The metabolic abnormalities induced by liver failure render the conventional assessment of nutritional status to be challenging. Preoperative loss of skeletal muscle mass, namely, sarcopenia, has a significant detrimental impact on post-transplant outcomes. It is essential to provide sufficient nutritional support during all phases of liver transplantation. Oral nutrition is preferred, but tube enteral nutrition may be required to provide the needed energy intake. Herein, the latest currently employed perioperative nutritional interventions in liver transplant recipients are thoroughly illustrated including synbiotics, micronutrients, branched-chain amino acid supplementation, immunonutrition formulas, fluid and electrolyte balance, the offering of nocturnal meals, dietary counselling, exercise and rehabilitation
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