Short-term changes in energy metabolism after 1 month of a regular oral diet in severely malnourished cirrhotic patients

• Published in: Metabolism, clinical and experimental Vol. 44; no. 6; pp. 765 - 770
• Main Authors: Campillo, Bernard, Bories, Phuong Nhi, Leluan, Monique, Pornin, Beatrice, Devanlay, Michel, Fouet, Paul
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.06.1995; Elsevier
• Subjects: Adult; Aged; Anthropometry; Biological and medical sciences; Blood Chemical Analysis; CIRRHOSIS; DIET; DIETA; ENERGIA; ENERGIE; ENERGY; ENERGY EXPENDITURE; Energy Intake; ENERGY METABOLISM; ENFERMEDADES HEPATICAS; ESTADO NUTRICIONAL; ETAT NUTRITIONNEL; Feces - chemistry; Female; Gastroenterology. Liver. Pancreas. Abdomen; HOMBRES; HOMME; Humans; Lipids - analysis; Liver Cirrhosis - complications; Liver Cirrhosis - metabolism; LIVER DISEASES; Liver. Biliary tract. Portal circulation. Exocrine pancreas; MALADIE DU FOIE; Male; MALNUTRICION; MALNUTRITION; Medical sciences; MEN; METABOLISME ENERGETIQUE; METABOLISMO ENERGETICO; Middle Aged; Nitrogen - analysis; Nutrition Disorders - complications; Nutrition Disorders - diet therapy; Nutrition Disorders - pathology; NUTRITIONAL STATUS; Other diseases. Semiology; Oxidation-Reduction; REGIME ALIMENTAIRE; Time Factors; Human; Cirrhosis; Energy metabolism; Diet therapy; Digestive diseases; Hepatic disease; Biological effect; Malnutrition; Nutritional status
• ISSN: 0026-0495; 1532-8600
• DOI: 10.1016/0026-0495(95)90190-6

Malnutrition in patients with liver cirrhosis is currently associated with abnormal fuel metabolism. The aim of this study was to evaluate changes in energy production and substrate oxidation rates in a group of 26 nonanorectic severely malnourished cirrhotic patients in stable clinical condition after 1 month of an oral diet. Child-Pugh score, nutritional status, energy expenditure, rates of nutrient oxidation, and plasma levels of intermediary metabolites in the postabsorptive phase were assessed before and after 1 month of oral nutrition. Upon entry onto the study, caloric and protein intakes were 40.1 ± 2.0 kcal/kg and 1.44 ± 0.8 g/kg, respectively. The Child-Pugh score did not change during the study, whereas nutritional status improved as shown by increased muscular midarm circumference, ([MMAC] P < .02), height-creatinine index ( P < .05), triceps skinfold thickness ([TST] P < .01), and fat mass ( P < .001). Inflammatory state improved during the study, as shown by the decrease of C-reactive protein ([CRP] P < .01) and orosomucoid ( P < .001). The ratio of caloric intake to resting energy expenditure (REE) increased (1.53 ± 0.06 v 1.66 ± 0.07, P < .05), as well as the rates of glucose oxidation ([Gox] 73.6 ± 9.9 v 128.1 ± 10.3 mg/min, P < .001) and urine nitrogen excretion (6.69 ± 0.47 v 7.96 ± 0.48 g/d, P < .02). On the other hand, the rate of lipid oxidation (Lox) decreased (67.3 ± 3.9 v 47.3 ± 4.9 mg/min, P < .001) and was correlated with the decrease of free fatty acid (FFA) levels ( P < .05). These results show that a regular oral diet may improve nutritional status in malnourished cirrhotic patients, provided caloric intake is well adapted to energy requirements. Improvement of nutritional status is related to the change in energy metabolism, showing a normalization of carbohydrate storage while mobilization of fat stores is reduced.