S3-Leitlinie der Deutschen Gesellschaft für Ernährungsmedizin (DGEM) in Zusammenarbeit mit der GESKES, der AKE und der DGVS

Zusammenfassung

Ziel: Mangelernährung wirkt sich negativ auf die Prognose aus und ist insbesondere bei Patienten mit chronischen Lebererkrankungen ein häufiger Befund. In der klinischen Praxis wird das Potenzial der Ernährungstherapie nicht völlig ausgeschöpft. Mit 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 Gesellschaft für Ernährungsmedizin (DGEM, ESPEN) zur enteralen und parenteralen 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 80 im Konsentierungsverfahren ermittelte Empfehlungen zur Ernährungstherapie leberkranker Patienten im Hinblick auf pathophysiologische Grundlagen, Indikationsstellung und Durchführung einer Ernährungstherapie sowie ihrer Ergebnisse. Empfehlungen werden für die Krankheitsbilder akutes Leberversagen (ALF), alkoholische Steatohepatitis (ASH), nicht alkoholische Steatohepatitis (NASH), Leberzirrhose (LC), Lebertransplantation und Operation sowie ernährungsbedingte Leberschädigung (NALI) gegeben.

Schlussfolgerung: Patienten mit chronischer Lebererkrankung leiden häufig an einer Mangelernährung; diese Patientengruppe profitiert daher von einer Ernährungstherapie. Die Datenlage ist bei ALF-Patienten wesentlich unsicherer, da nur wenige Untersuchungsergebnisse für diese schwere aber seltene Erkrankung vorliegen.

Abstract

Aim: Malnutrition carries a poor prognosis and is a frequent finding especially in patients with chronic liver disease. In clinical practice, however, the potential of nutrition therapy frequently is not fully employed. 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 enteral and parenteral 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 AEZQ (Agency for Quality in Medicine).

Results: The present guideline comprises 80 recommendations developed in a consensus process on the nutritional therapy of patients with liver disease with regard to pathophysiological principles, indication for and application of nutritional therapy and the resulting outcome. Recommendations are given for the following conditions: acute liver failure (ALF), alcoholic steatohepatitis (ASH), non-alcoholic steatohepatitis (NASH), liver cirrhosis (LC), liver transplantation and surgery, as well as nutrition associated liver injury (NALI).

Conclusion: Patients with chronic liver disease frequently suffer from malnutrition; therefore, this group of patients benefits from nutrition therapy. For patients with ALF evidence is poor because there are only few research results for this severe but rare condition.

Schlüsselwörter

Leitlinie - akutes Leberversagen - alkoholische Steatohepatitis - nicht alkoholische Steatohepatitis - Leberzirrhose - Lebertransplantation - ernährungsbedingte Leberschädigung

Keywords

clinical practice guideline - acute liver failure - alcoholic steatohepatitis - non-alcoholic steatohepatitis - liver cirrhosis - liver transplantation - nutrition-associated liver injury

^* DGEM Steering Committee: Bischoff SC, Lochs H, Weimann A sowie das DGEM-Präsidium

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