Nutrition and Obesity Pre/Post Transplant Kim

Transcript:Nutrition and Obesity Pre/Post Transplant Kim:
Nutrition and Obesity Pre/Post Transplant Kim Flack MS, RD, CNSC, LDN Liver Transplant Dietitian Topics The pre-transplant nutrition evaluation Optimizing nutrition prior to transplant Strategies/tips on reaching daily intake goals Nutrition challenges during hospitalization Nutrition after transplant Pre-Transplant Nutrition Evaluation Identify nutrition problems – diet intolerance, unintended weight loss, uncontrolled diabetes, malnutrition Complete hand-grip strength – frailty, malnutrition assessment Nutrition prescription Nutrition education – intervention to support transplant success Identify nutritional barriers to transplant Limitations of Body Mass Index (BMI) Does not determine the state of nutrition BMI doesn’t tell us any information about behaviors Age, Sex, Race/Ethnicity not considered Does not differentiate between fat and lean body mass. A healthy, muscular person may have a BMI in a high range while a frail, inactive person may have a low BMI with more body fat and less lean body mass Malnutrition Can be undernourished or malnourished and have a high BMI. Malnutrition is universally prevalent among pre-liver transplant patients. Patients with malnutrition have longer hospital stays, increased incidence of ascites and hepatorenal syndrome, as well as increased mortality (Fortier, 2018) Characteristics Reduced energy intake Weight loss Body fat loss– mild, severe Muscle mass loss– mild, severe Fluid accumulation Grip strength (severe malnutrition) – reduced for age/gender Sarcopenic Obesity A progressive and diffuse loss of skeletal muscle strength, mass and function. The coexistence of obesity and muscle mass loss is known as sarcopenic obesity. Mortality is high in sarcopenic patients waiting for liver transplantation when compared to non-sarcopenic patients. A meta-analysis found that pre-transplant sarcopenic obesity proved to be a risk factor after liver transplant and was associated with two times higher mortality at short- and long-term follow-up (Hegyi, 2020) Frailty and Obesity Transplant Headlines Clinical Liver Disease 2021, 17;4:271-276 The Impact of Frailty, Sarcopenia, and Malnutrition on Liver Transplant Outcomes Weight Loss Strategies Energy restriction and exercise are key approaches to weight loss, and we need to ask them about their experiences and help them feel supported. Inadequate energy intake = risk of becoming malnourished When losing weight, make small changes that can be easily maintained. To maintain muscle strength, protein intake must be maintained Protein Choices Keep Moving and Stay Active Participate in regular exercise to prevent muscle loss. Exercise helps burn calories and build muscles. As medically appropriate include 3 days per week of moderate physical activity (walking or cycling) for 30 minutes and 2 days per week