RESUMO Racional: A doença hepática crônica está associada à desnutrição que afeta negativamente a qualidade de vida relacionada à saúde (QVRS). Objetivo: Avaliar o efeito da suplementação aguda de proteína do soro de leite na QVRS e no estado nutricional e funcional dos pacientes em lista de espera para o transplante hepático. Métodos: Ensaio clínico randomizado com pacientes à espera do transplante hepático que foram randomizados em dois grupos: PS (suplementação com proteína do soro de leite) e Controle (suplementação com caseína). Ambos os grupos receberam 40 g das proteínas (20 g pela manhã e 20 g à noite) por 15 dias. O estado nutricional e funcional foi avaliado. O balanço energético foi calculado como a diferença entre a ingestão energética (recordatório de 24 horas) e o gasto energético total (avaliado por calorimetria indireta). O questionário de doença hepática crônica (CDLQ) foi utilizado para avaliar a QVRS. Todas as medidas foram realizadas antes e após a intervenção. Resultados: Cinquenta e seis pacientes foram avaliados. A desnutrição esteve presente em 56,9% e, diretamente associada à baixa QVRS (p<0,05). A suplementação, com ambas as proteínas, não alterou o estado nutricional e funcional dos pacientes (p>0,05). Entretanto, a QVRS melhorou após a suplementação com PS e caseína, sem diferenças entre os grupos (p>0,05). Pacientes que alcançaram as necessidades proteicas e com balanço energético positivo tiveram maior escore de QVRS (4,9; p<0,05), sem diferenças entre os grupos (p>0,05). Conclusão: A desnutrição reduz substancialmente a QVRS. A suplementação aguda com PS ou caseína melhorou de forma similar a QVRS.

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.

RESUMO Racional: Existe lacuna na literatura em relação à presença de hipercalemia em pacientes submetidos ao transplante hepático. Objetivo: Avaliar a prevalência de hipercalemia após o transplante hepático; e avaliar os fatores de risco associados a essa condição. Métodos: Estudo de coorte retrospectivo, no qual foram avaliados 147 pacientes submetidos ao transplante hepático, com tempo de seguimento de um ano. A coleta de dados compreendeu gênero, idade, valores séricos de potássio, ureia, creatinina, sódio e medicamentos utilizados no tempo de 1, 6 e 12 meses após o transplante. Hipercalemia foi definida como valores de potássio sérico maiores do que 5,5 mEq/l. Resultados: Hipercalemia foi observada em 18,4%, 17,0% e 6,1% dos pacientes no 1º, 6º e 12º meses após o transplante, consecutivamente. Idade avançada (p=0,021), baixos valores de creatinina sérica (p=0,007), valores aumentados de ureia (p=0,010) e hipernatremia (p=0,014) foram fatores associados à hipercalemia, assim como a dose de prednisona no 6º mês após o transplante (p=0,014). Conclusão: Hipercalemia esteve presente em menos de 20% dos pacientes no primeiro mês após o transplante hepático, com diminuição da prevalência ao longo do tempo. Considerando que ela não afeta todos os pacientes, o tratamento dietético deve ser individualizado, com especial atenção à recomendação de administração de potássio de forma rotineira.

ABSTRACT Background: There is a lack of data regarding hyperkalemia after liver transplantation. Aim: To evaluate the prevalence of hyperkalemia after liver transplantation and its associated factors. Methods: This retrospective cohort study evaluated 147 consecutive post-transplant patients who had at least one year of outpatient medical follow up. The data collection included gender, age, potassium values, urea, creatinine, sodium and medication use at 1, 6 and 12 months after. Hyperkalemia was defined as serum potassium concentrations higher than 5.5 mEq/l. Results: Hiperkalemia was observed in 18.4%, 17.0% and 6.1% of patients 1, 6 and 12 months after tranplantation, respectively. Older age (p=0.021), low creatinine clearance (p=0.007), increased urea (p=0.010) and hypernatremia (p=0.014) were factors associated with hyperkalemia, as well as the dose of prednisone at six months (p=0.014). Conclusion: Hyperkalemia was prevalent in less than 20% of patients in the 1st month after liver transplantation and decreased over time. Considering that hyperkalemia does not affect all patients, attention should be paid to the routine potassium intake recommendations, and treatment should be individualized.

Abstract Patients who need prolonged domiciliary enteral nutritional therapy may benefit from handmade diets. However, the preparation of such diets might cause insecurity with regard to their nutritional composition and physical-chemical properties. Current study analyzes the osmolality and Hydrogen-Ion concentration (pH) on handmade enteral diets. To this purpose, six formulas and two juices, prescribed on discharge from hospital, were analyzed physically and chemically. Osmolality and pH were respectively determined by cryoscopy and potentiometry. Most formulations were classified as isosmolar (with less than 400 mOsm/kg solvent), and only one was classified as slightly hyperosmolar, with rates ranging from 356.7 to 403.5 mOsm/kg solvent. On average, the standard formula presented higher osmolality than similar ones prepared for hyperglycemia. Among the juices, only one registered hyperosmolar concentration of 595.54 mOsm/kg solvent. All formulas presented pH rates classified as low acidity, ranging between 6.1 and 6.6, while the two juices had the lowest results, 4.73 and 4.66 each. The blend of ingredients used in handmade formulas and juices studied presented acceptable osmolality and pH rates for a safe administration and absence of gastrointestinal complications. Data showed here are consistent with an appropriate and healthy diet and contributed towards success in domiciliary enteral nutritional therapy.

Resumo Objetivo: Desenvolver e analisar a composição de macro e micronutrientes de dietas enterais semiartesanais para uso domiciliar. Método: Foi desenvolvida uma receita de dieta enteral semiartesanal padrão, com três concentrações calóricas, de 1500, 1800 e 2100 Kcal. Após o preparo e teste de viscosidade, estabilidade, odor, cor e custo as dietas tiveram a composição química de macro e micronutrientes analisada. O folato e vitamina D e B12 tiveram seus valores estimados por meio de tabelas de composição química. Os resultados encontrados foram comparados com as recomendações nutricionais para idosos. Resultado: As dietas apresentaram distribuição normal de macronutrientes. A dieta de 1500 Kcal apresentou diversas deficiências de minerais e vitaminas. Nos demais níveis calóricos, obteve-se valores adequados para todos os minerais exceto o magnésio. As vitaminas estavam todas adequadas no nível calórico de 2100 Kcal e no de 1800 Kcal, a vitamina E, D e B6 não alcançaram as recomendações dietéticas diárias. Conclusão: A dietas padrões desenvolvidas podem contribuir para segurança alimentar e nutricional de idosos em terapia nutricional domiciliar, desde que todas suplementadas com magnésio, e a de 1800 Kcal com vitamina E, D e B6. A fórmula de 1500 Kcal não se mostrou segura nutricionalmente no que tange aos micronutrientes.

Abstract Objective: the development and analysis of the macro and micronutrient composition of homemade enteral diets. Method: A standard homemade enteral diet was developed at three caloric concentrations - 1500, 1800 and 2100 Kcal. After preparation and testing of viscosity, stability, odor and color, plus evaluation of cost, the chemical composition of the nutrients of the diets were analytically determined. Folic acid, vitamin D and vitamin B12 values were calculated using chemical composition tables. The results were compared with recommended nutritional standards for the elderly. Result: The diets exhibited normal macronutrient distribution. The 1500 caloric level presented some mineral and vitamin deficiencies. Suitable values were obtained at the other caloric levels for all minerals except magnesium. There were appropriate levels of all the vitamins in the 2100 Kcal diet, while vitamin E, D and B6 levels were below the recommended dietary allowances in the 1800 Kcal diet. Conclusion: The standard homemade enteral diets studied can contribute to the food and nutritional safety of elderly persons undergoing home care, if all are supplemented with magnesium and the 1800 Kcal diet is supplemented with vitamin E, D and B6. The 1500 Kcal diet was not nutritionally safe in terms of micronutrients.