POSTPRANDIAL DE-NOVO LIPOGENESIS IN ALCOHOLIC LIVER-CIRRHOSIS - RELATIONSHIP WITH FUEL HOMEOSTASIS AND NUTRITIONAL-STATUS

The prevalence and nutritional consequences of postprandial de novo li pogenesis were evaluated in 24 stable alcoholic cirrhotic patients. En ergy expenditure and the rates of nutrient oxidation were assessed by indirect calorimetry after an overnight fast and 2h after a standard m eal supplying 15 kcal/kg (63kJ/kg) of body weight. Postprandially, net lipogenesis occurred in 16 patients (group L+) as shown by a respirat ory quotient clearly above 1.00 (P < 0.01). The rate of lipid oxidatio n remained positive in 8 patients (group L-). The main mechanism invol ved in this metabolic pathway appeared to be a sharp postprandial hype rinsulinaemia. When compared to group L+, patient group L- showed an i mpaired thermic effect of food (P < 0.05), a lower rate of glucose oxi dation (P < 0.05) and a mild hyperketonaemia (P < 0.05) at fasting lev els. Muscular and fat masses were lower (respectively P < 0.05 and P = 0.05) and the severity of the disease as assessed by the Child-Pugh c lassification was more pronounced in this group (P < 0.02). The occurr ence of postprandial lipogenesis in stable cirrhotic patients is relat ed to better nutritional status. Such a metabolic pathway may explain the nutritional heterogeneity of cirrhotics and is likely to have an e ffect on the benefits of refeeding.