Nutritional support in alcoholic cirrhotic patients improves host defenses

Background: Malnutrition is usual in patients with alcoholic liver disease and is associated with a poor outcome. Nutritional support decreases nutrit ion-associated complications. Aim: To demonstrate that nutritional support in ambulatory alcoholic cirrho tic patients improves host defenses. Methods: Thirty-one male outpatients with alcoholic cirrhosis CHILD-PUGH B or C were included. Twenty-five subjects completed six months consuming dai ly a nutritional supplement (Ensure(R), 1000 Kcal and 35 g protein), in add ition to their regular diet. At entrance and every three months, a clinical assessment, nutritional evaluation and indirect calorimetry were performed . Liver function tests and LPS-induced monocyte production of cytokines, sa livary secretory IgA, lactulose/mannitol ratio and breath hydrogen tests we re also measured in these intervals. Delayed cutaneous hypersensitivity and IgG and IgM antibody response to endotoxin were assessed at entrance and a t the end of the study. Results: Patients drank 85% of the provided supplement as an average. REE, total body fat and serum albumin increased, basal breath hydrogen decreased and cellular immunity improved significantly during the follow up period ( p less than or equal to 0.03). All the other parameters remained unchanged throughout the study. Six patients (16.2%) died during the study, five due to upper gastrointestinal bleeding. Conclusion: Nutritional support in alcoholic cirrhotic patients improves nu tritional status and cell mediated immunity.