Improvement of fuel metabolism by nocturnal energy supplementation in patients with liver cirrhosis

Aims: patients with liver cirrhosis exhibit abnormal fuel metabolism, inclu ding increased fat and decreased glucose oxidation. Such altered energy met abolism is similar to that observed after starvation and could lead to maln utrition. We therefore studied whether nocturnal energy supplementation mig ht improve the fuel metabolism in cirrhotic patients. Methods: 12 cirrhotic patients and 14 healthy controls participated in this study. Subjects in t he two groups ate isonitrogenous (1.2 g/kg/day) and isocaloric (35 kcal/day ) diets for 1 week before and during the study. On day 1 of the study, indi rect calorimetry was carried out in the morning after an overnight fast. Th e next morning, the same measurement was performed after the patients took a liquid nutrient (Ensure Liquid(R), 250 kcal) at 23:00 on day 1. Respirato ry quotient (RQ), resting energy expenditure (REE), and substrate oxidation rates of glucose (% CHO), fat (% FAT) and protein were estimated from meas ured VO2, VCO, and urinary nitrogen. Results: Significant decreases in RQ, and % CHO and a significant increase in % FAT were observed at baseline in cirrhotic patients as compared with controls. After the nocturnal energy su pplementation, RQ, % CHO and % FAT in cirrhotic patients were significantly recovered, ending at levels close to normal. Conclusions: These results su ggest that nocturnal energy supplementation could be useful to correct abno rmal fuel metabolism and to prevent malnutrition in cirrhosis. (C) 2000 Els evier Science Ireland Ltd. All rights reserved.