Ra. Richardson et al., Chronic liver disease and transplantation - uncovering the role of the liver in ingestive behaviour, CLIN NUTR, 20, 2001, pp. 141-145
The liver is an important metabolic sensor relaying humoral and neural sign
alling via the brain stem to the hypothalamus. The integration of this info
rmation in the higher centres ultimately controls the composition, duration
and frequency of nutritional intake. In chronic liver disease, alterations
in oxidative metabolism and impairment of the liver's metabolic role may a
ffect changes in ingestive behaviour and nutritional status. In cirrhosis u
ndernutrition is prevalent, whereas following transplantation rapid weight
gain is observed. Liver transplant recipients lose all extrinsic hepatic in
nervation and the absence of humoral and neural responses relayed via hepat
ic afferents could affect energy homeostasis and contribute to weight gain.
Recent in vivo work suggests that patients with hepatocellular cirrhosis h
ave the greatest metabolic disturbances, poorest intakes and nutritional st
atus when compared with patients with cholestatic cirrhosis. Stratification
of patients by disease severity had no differential effect. Conversely fol
lowing transplantation, patients' weights significantly exceed pre-illness
values. Evidence suggests that these patients exhibit an energy economy and
a shift to increased energy intake from fat. It may be postulated that the
liver transplant procedure per se is implicated in development of obesity.
The sensing of energy metabolism and food intake are likely to be differen
t in liver cirrhosis and after transplantation. Changes in energy intake an
d body composition evident in liver cirrhosis and liver transplantation are
consistent with its role as an energy sensor. (C) 2001 Harcourt Publishers
Ltd.