S2k-Leitlinie Klinische Ernährung in der Hepatologie

Zusammenfassung

Ziel Sowohl Über- als auch Unterernährung spielen für die Prognose von Patienten mit Leberkrankheiten eine bedeutende Rolle. Bei chronischer Leberkrankheit besteht häufig eine Mangelernährung mit gestörter Körperzusammensetzung, allerdings zeigt sich in den letzten Jahren ein Wandel des klinischen Spektrums mit Zunahme von Adipositas und sarkopener Adipositas. In der klinischen Praxis wird das Potenzial der Ernährungstherapie als metabolisches Management einer Leberkrankheit oft unterschätzt und nicht ausgeschöpft. Mit der Aktualisierung dieser Leitlinie sollen umfassende aktuelle und evidenzbasierte Empfehlungen für die Ernährungstherapie von Patienten mit Lebererkrankungen gegeben werden.

Methoden Frühere Leitlinien der Deutschen und der Europäischen Gesellschaften für Ernährungsmedizin (DGEM, ESPEN) zur Ernährung von Patienten mit Lebererkrankungen wurden entsprechend den Prinzipien der AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften) und ÄZQ (Ärztliche Zentralstelle für Qualitätssicherung) aktualisiert und vollständig überarbeitet und erweitert.

Ergebnisse Die vorliegende Leitlinie umfasst 110 im Konsentierungsverfahren ermittelte Aussagen und Empfehlungen zum ernährungsmedizinischen metabolischen Management leberkranker Patienten im Hinblick auf pathophysiologische Grundlagen, Indikationsstellung und Durchführung einer Ernährungstherapie sowie ihrer Ergebnisse. Empfehlungen werden für die Krankheitsbilder akutes Leberversagen (ALV), alkoholassoziierte Lebererkrankung (ALD), metabolische Dysfunktion-assoziierte Fettleberkrankheit (MASLD), Leberzirrhose (LZ), Lebertransplantation und Operation sowie ernährungsbedingte Leberschädigung (NALI) gegeben.

Schlussfolgerung Bei Patienten mit chronischer Lebererkrankung liegt häufig ein prognostisch ungünstiger metabolischer Status vor mit gestörter Körperzusammensetzung und Mangelernährung oder Adipositas; diese Patientengruppe profitiert von einem evidenzbasierten ernährungsmedizinischen metabolischen Management. Bei Patienten mit akutem Leberversagen ist die Datenlage wesentlich unsicherer, da nur wenige Studiendaten für diese schwere, aber seltene Erkrankung vorliegen.

Abstract

Aim Overnutrition as well as undernutrition have a major prognostic role for patients suffering from liver disease. In chronic liver disease, impaired body composition and malnutrition are common findings. In recent years, however, the clinical presentation has changed with an increasing proportion of obese and sarcopenic obese liver patients. More often than not the potential of metabolic management by nutrition support remains unrecognized and underused. The current update of this guideline is aimed at giving comprehensive, up-to-date and evidence-based recommendations for nutrition therapy in patients with liver disease.

Methods Previous guidelines of the German and European Societies for Nutritional Medicine (DGEM, ESPEN) on nutrition in patients with liver disease were updated and thoroughly revised and extended according to the requirements of the AWMF (German Association of the Scientific Medical Societies) and the ÄZQ (Agency for Quality in Medicine).

Results The present guideline comprises 110 statements and recommendations developed in a consensus process on the nutritional metabolic management of patients with liver disease with regard to pathophysiological principles, indication for and application of nutritional therapy and the resulting outcome. Recommendations address the following conditions: acute liver failure, alcohol-associated liver disease, metabolic dysfunction-associated liver disease, liver cirrhosis, liver transplantation and surgery, as well as nutrition associated liver injury.

Conclusions Patients with chronic liver disease frequently exhibit an unfavourable nutritional metabolic status with impaired body composition and malnutrition or obesity; this group of patients benefits from evidence based nutritional metabolic management. For patients with acute liver failure evidence is weak because there is only few data from studies in this severe but rare condition.

Schlüsselwörter

Sarkopenie - ernährungsbedingte Leberschädigung - akutes Leberversagen - Fettlebererkrankung - alkoholische Steatohepatitis - nicht-alkoholische Fettlebererkrankung - Leberzirrhose - Transplantation

Keywords

sarcopenia - nutrition associated liver injury - acute liver failure - fatty liver disease - alcoholic steatohepatitis - non-alcoholic steatohepatitis - liver cirrhosis - transplantation

^† verstorben

Publication History

Article published online:
26 August 2024

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