DAILY ENERGY AND SUBSTRATE METABOLISM IN PATIENTS WITH CIRRHOSIS

Twenty-four-hour energy expenditure (EE) and substrate oxidation (resp iratory chamber), and whole-body glucose uptake and oxidation rates (e uglycemic hyperinsulinemic clamp [EHC] and indirect calorimetry) were measured in 10 male patients with posthepatitis, Child B cirrhosis, an d 8 healthy male controls matched for age, body size, and body composi tion. Twenty-four-hour EE was higher in cirrhotic patients than in con trols (8,567 +/- 764 vs. 6,825 +/- 507 kJ/d; P < .001), Resting energy expenditure (REE) was also higher in cirrhotic patients than in contr ols (7,881 +/- 1,125 vs. 5,868 +/- 489 kJ/d; P < .01). Twenty-four-hou r respiratory quotient (RQ) (trend) and fasting RQ (0.76 +/- 0.05 vs. 0.82 +/- 0.04; P < .05) were lower in cirrhotic patients than in contr ols, reflecting higher lipid oxidation rates in the former group. Whol e-body glucose uptake was markedly reduced in cirrhotic patients when compared with controls (22.4 +/- 3.2 vs. 44.5 +/- 7.6 mmol/kg/min; P < .001). Carbohydrate oxidation rates, computed during the last 40 minu tes of the clamp, were 8.5 +/- 1.1 mmol/kg/min in cirrhotic patients a nd 22.6 +/- 6.1 mmol/kg/min in controls (P < .001). Nonoxidative gluco se disposal was 13.9 +/- 2.5 mmol/kg/min in cirrhotic patients and 22. 0 +/- 5.5 mmol/kg/min in normal controls (P < .01). In conclusion, our data indicate that patients with Child B cirrhosis who still maintain a nutritional status (i,e., body composition) comparable with healthy controls are characterized by a cluster of metabolic defects that inc lude hypermetabolism increased lipid utilization, and insulin resistan ce. This suggests that tile above metabolic syndrome precedes and prob ably leads to malnutrition in the natural history of the liver disease . In fact, in spite of the absence of a significant difference in calo ric intake between cirrhotic patients and normal controls, the elevate d 24-hour EE might allow for a relevant weight loss in cirrhotic patie nts, because, with time, the differences may be cumulative. However, w hether this hypermetabolism can lead to a real weight loss remains to be evaluated in a longitudinal study.