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Cholestatische Lebererkrankungen gehen mit einem hohen Risiko für Mangelernährung, u.a. Proteinenergiemangelernährung und einem Mangel an spezifischen Nährstoffen, einher. Der Ernährungsstatus kann auf der Grundlage anthropometrischer Messungen bewertet werden, die jedoch aufgrund von Aszites und peripheren Ödemen irreführend sein können. Zur Beurteilung des Nährstoffbedarfs muss der Status der fettlöslichen Vitamine biochemisch bestimmt werden. Die Ernährungstherapie ist dann, ausgehend von einer Bewertung des Ernährungsstatus, nach einem festgelegten Programm zu planen. Das Grundprinzip des Ernährungsmanagements besteht darin, den Ernährungsstatus zu korrigieren und das Risiko für einen Nährstoffmangel zu senken. Kinder mit Cholestase benötigen in der Regel eine zusätzliche Energiezufuhr, die entweder über eine energiedichtere Nahrung oder über die Supplementierung von Glucosepolymeren und Lipiden erreicht werden kann. Um ein Aufholwachstum zu erzielen, ist in der Regel die Proteinaufnahme zu erhöhen. Besonderes Augenmerk sollte auf die Supplementierung fettlöslicher Vitamine gelegt werden, wobei ein schlechter Vitamin E-Status nicht leicht zu beheben ist. Bei einigen Kindern ist eine parenterale Verabreichung von Vitamin K erforderlich. In jüngster Zeit wurden gute Behandlungserfolge mit einer oral verabreichten, wasserlöslichen Vitamine E-Zubereitung (D-α-Tocopherol-Polyethylenglykol-1000-Succinat) erzielt. Da viele cholestatische Lebererkrankungen progredient verlaufen und letztendlich zu Leberversagen führen, kann eine Ernährungs- therapie häufig als «Überbrückung» bis zur Durchführung einer Lebertransplantation betrachtet werden, welche die Prognose des Patienten verbessert. Bei einer schweren Lebererkrankung ist somit eine invasive Form der Ernährungstherapie indiziert, bei der das Kind in der Regel nachts über eine Nasen-Magen-Sonde oder sogar parenteral ernährt wird.
Annales Nestlé (Deutsche Ausg.) – Karger
Published: Oct 1, 2009
Keywords: Lebererkrankung; Fettlösliche Vitamine; Vitamin E; Mangelernährung; Parenterale Ernährung; Leberversagen; Enterale Ernährung
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