Nutrition Support of Children with Chronic Liver Diseases: A Joint Position Paper of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition
Sumit Kumar Singh
Abstract
Introduction:Malnutrition is a known as well as a common complication of childhood chronic liver diseases (CLD) including cholestatic and end-stage liver diseases.It is associated with increased morbidity and mortality of the patients with CLD.Identification of the nutritional deficiency is of utmost importance especially in children with end-stage liver disease requiring transplantation, as optimized pre-transplant nutrition may hasten post-transplant recovery while simultaneously decreasing complications. Aims:1. To summarizes the available literature on various aspects of nutrition in children with chronic liver diseases (CLD).2. To discuss the challenges and approaches in the nutritional assessment of children with CLD 3. To summarize the pathophysiology of the malnutrition in the context of CLD and to treatment recommendations and future research focus Pathophysiology of malnutrition in children with chronic liver disease:There are various risk factors associated with development of malnutrition in children with cholestasis and end-stage liver disease and are summarized in figure 1. Children with cholestatic liver diseases suffer from maldigestion and malabsorption of nutrients from the very early stage of disease.Later on, with the progression to end-stage liver disease, the factors such as anorexia, nausea and vomiting, abnormal nutrient metabolism, increased energy expenditure and iatrogenic factors also come to the play making the process more complex. Nutritional Status Assessment• History: daily oral/enteral intake, medication history, socioeconomic factors, such as access to food and vitamins or supplements.• Physical Examination: Anthropometry (weight, height, mid upper arm circumference (MUAC), triceps skin folds (TSF).Look for features of protein, essential fatty acid, and fat-soluble