ONE-MONTH REGULAR ORAL NUTRITION IN ALCOHOLIC CIRRHOTIC-PATIENTS - CHANGES OF NUTRITIONAL-STATUS, HEPATIC-FUNCTION AND SERUM-LIPID PATTERN

The effect of a regular oral diet supplying 167 kJ/kg per d (40 kcal/k g per d) on nutritional state, liver function and serum lipid profile was assessed in thirty severely malnourished alcoholic cirrhotic inpat ients. Their diet was monitored by a trained dietitian and they were v igorously encouraged to eat all meals served. One month after their en try into the study, protein and energy intakes were significantly high er (P < 0.001) in keeping with an improvement of their nutritional sta tus as evaluated by means of height-creatinine index, muscular mid-arm circumference, tricipital skinfold thickness (P < 0.01 for all) and f at mass (P < 0.001), Assessment of liver function tests showed that le vels of aspartate aminotransferase (EC 2.6.1.1), gamma-glutamyl transf erase (EC 2.3.2.2) and bilirubin decreased (P < 0.05, P < 0.02 and P < 0.05 respectively) while prothrombin time values increased (P < 0.05) . Similarly, serum albumin increased modestly while transthyretin did not change. Orosomucoid and C-reactive protein decreased (P < 0.001 an d P < 0.01 respectively), indicating an improvement of the inflammator y state. Apolipoprotein Al and high-density-lipoprotein (HDL)-choleste rol correlated with several tests of liver function and improved signi ficantly during the study period (P < 0.001 and P < 0.02 respectively) . Moreover, changes in cholesterol and HDL-cholesterol correlated with those in transthyretin (P < 0.02 and P < 0.05 respectively). The chan ges in ApoA1 and HDL-cholesterol were greater in patients whose fat ma ss increased significantly. Our findings show that adequate oral nutri tion resulted in a better nutritional status in cirrhotics after 1 mon th of hospitalization. The serum lipid variables appeared to be more u seful indicators of functional liver improvement than the classic live r function tests which rather indicate liver damage.