Etiología y mecanismos de desnutrición en el paciente cirrótico

espanolEl higado juega un rol en la homeostasis calorica; esta comprometido en el proceso digestivo, y es frecuente encontrar desnutricion en la cirrosis, por incapacidad para satisfacer sus requerimientos de macro y micronutrientes. La patogenesis de desnutricion en la cirrosis es multifactorial, compleja y dificil de ser comprendida, incluye ingesta reducida de nutrientes, biosintesis disminuida, aumento de la perdida de proteina, absorcion intestinal deficiente, disturbios en la utilizacion del substrato, anormalidades en el metabolismo de carbohidratos, lipidos y proteinas asi como aumento de citoquinas pro inflamatorias, resultando en hipermetabolismo y aumento del gasto proteina-energia y de los requerimientos. La evaluacion nutricional es trascendental para un enfoque clinico-terapeutico, por su implicancia pronostica y la respuesta al trasplante hepatico. Aun con la evidencia de la prevalencia de desnutricion en cirroticos, continua poco reconocida, poco diagnosticada y muy poco tratada. Existe controversia si la desnutricion puede ser revertida en cirroticos; aunque hay un acuerdo sobre la necesidad de mejorar la ingesta de alimentos evitando las limitaciones y restricciones no basadas en la evidencia. EnglishThe liver plays a role in the caloric homeostasis; it is involved in the digestive process, so it is not surprising to find malnutrition in cirrhosis, because they have an inability to meet their macro and micronutrient requirements. The pathogenesis of malnutrition is multifactorial and complex and frequently difficult to understand and includes reduced nutrient intake, decreased protein biosynthesis and increased loss, poor intestinal absorption, disturbances in the use of the substrate, abnormalities in the metabolism of carbohydrates, lipids and proteins and increased of pro-inflammatory cytokines resulting in a hypermetabolic state as well as increase in protein-energy expenditure and requirements. The evaluation of nutritional status is transcendental for a clinical-therapeutic approach, due to its influence on the prognosis and response to liver transplantation. Despite the evidence on the prevalence of malnutrition in liver cirrhosis, this condition remains poorly recognized, poorly diagnosed and poorly treated. It is controversial, if malnutrition can be reversed in cirrhotic; there is an agreement about the need to improve the food intake, avoiding limitations and restrictions that are not based on evidence