SHORT-TERM CHANGES IN ENERGY-METABOLISM AFTER 1 MONTH OF A REGULAR ORAL DIET IN SEVERELY MALNOURISHED CIRRHOTIC-PATIENTS

Malnutrition in patients with liver cirrhosis is currently associated with abnormal fuel metabolism. The aim of this study was to evaluate c hanges in energy production and substrate oxidation rates in a group o f 26 nonanorectic severely malnourished cirrhotic patients in stable c linical condition after 1 month of an oral diet. Child-Pugh score, nut ritional 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 o nto the study, caloric and protein intakes were 40.1 +/- 2.0 kcal/kg a nd 1.44 +/- 0.8 g/kg, respectively. The Child-Pugh score did not chang e during the study, whereas nutritional status improved as shown by in creased muscular midarm circumference, ([MMAC] P < .02), height creati nine 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 orosom ucoid (P < .001). The ratio of caloric intake to resting energy expend iture (REE) increased (1.53 +/- 0.06 v 1.66 +/- 0.07, P < .05), as wel l 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 7.9 6 +/- 0.48 g/d, P < .02). On the other hand, the rate of lipid oxidati on (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 nutritio nal status in malnourished cirrhotic patients, provided caloric intake is well adapted to energy requirements. Improvement of nutritional st atus is related to the change in energy metabolism, showing a normaliz ation of carbohydrate storage while mobilization of fat stores is redu ced. Copyright (C) 1995 by W.B. Saunders Company