GLUCOSE-METABOLISM AND LIVER-CIRRHOSIS

Chronic liver disease is characterized by numerous metabolic alteratio ns, predominantly catabolic, resulting in the clinical picture of maln utrition and even cachexia in some patients. The following review focu ses on disturbances of glucose metabolism and of hormonal interactions that could contribute to the clinical picture of malnutrition seen in chronic liver disease. Body composition is altered in a characteristi c manner with an increase in fat mass and a significant loss of muscle tissue. Furthermore, defective glucose storage due to reduced insulin sensitivity predominantly of muscle tissue has been observed. The pat hogenesis of insulin resistance leading to an impaired glucose toleran ce or a manifest diabetes mellitus is as yet unknown. A receptor/ post receptor dysfunction probably exists in chronic liver disease that mig ht be explained by the following factors: 1. Altered membrane lipid co mposition and increased levels of free fatty acids; 2. long-lasting hy perinsulinemia; 3. increased plasma levels of insulin counteracting ho rmones such as, growth hormone, glucagon, catecholamines and possibly cytokines; 4. a lack of liver-derived humoral factors with insulin-lik e activity, i.e. insulin-like growth factors I and II.