Malnutrition is a characteristic finding in patients withWe investigated adipose tissue fatty acid composition decompensated cirrhosis and is associated with poor recovery in 22 moderately to severely malnourished patients with following orthotopic liver transplantation (OLT), 1-9 the degree cirrhosis and in 22 healthy volunteers by in vivo carbonof malnutrition having been correlated to posttransplantion 13 magnetic resonance spectroscopy (MRS). Gas-liquid mortality. 9 In this patient population, malnutrition also inchromatography (GLC) of adipose tissue samples was creases the morbidity because of complications such as ascialso performed in 11 of the patients and in 4 volunteers.tes and hepatic encephalopathy. It is therefore a major factor In vivo 13 C magnetic resonance spectra were obtained determining the outcome of patients with chronic liver disfrom the subcutaneous adipose tissue before and after ease and may influence the success of any treatment modaleight weeks following orthotopic liver transplantation ity. 1-2,10-11 (OLT). Adipose tissue biopsy samples were obtained for GLC analysis at the time of transplantation in the paMalnutrition in cirrhosis arises from a combination of factients and at inguinal hernia repair in the 4 volunteers. tors, including an insufficient calorie intake, accelerated proNo significant differences were found in the subcutane-tein breakdown, and inefficient protein synthesis. 1,3,12-13 Choous adipose tissue total-saturated, -polyunsaturated or lestatic liver disorders, such as primary biliary cirrhosis -monounsaturated fatty acid composition between pa-(PBC) and primary sclerosing cholangitis (PSC) are associtients and healthy volunteers by in vivo 13 C MRS. GLC ated with the decreased intraluminal concentration of bile analysis of adipose tissue samples confirmed that total salts resulting in lipid malabsorption and the further deplelevels of saturated, poly-, and monounsaturated fatty tion of body fat stores. 12,14 In addition, patients with cirrhosis acids remained the same but revealed significant differ-have abnormalities in energy metabolism with a reduced caences in levels of individual fatty acids, particularly n-pacity to store glycogen in the liver, thereby affecting gluco-3 fatty acids (total n-3, cirrhotics: .84% { .07% vs. controls: neogenesis. 15 These changes demand the use of alternative 1.36% { .13%, P õ .01). Eight weeks following trans-fuel sources, such as lipids and protein, resulting in an inplantation, recipients showed a considerable increase in creased breakdown of adipose tissue and muscle. 13 body mass (pretransplantation: 59.3 { 3.2 vs. posttransAberrations in fatty acid synthesis and utilization have plantation: 63.2 { 3 kg, P õ .01). 13 C MRS revealed a previously been observed in patients with cirrhosis. 15a-18 Pasignificant increase in saturated fatty acids (pretrans-tients with advanced functionally decompensated cirrhosis plantation: 21.6 { 2.8 vs. posttransplantation: 25.5% { have abnormal levels of plasma long-chain polyunsaturated 1.2...