Changes in adipose tissue composition in malnourished patients before and after liver transplantation: A carbon-13 magnetic resonance spectroscopy and gas-liquid chromatography study

Abstract

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...

Nutritional Therapy in Liver Transplantation

“…Both are cell membrane components and precursors of a wide array of biologically active compounds. Lipid should be provided by using emulsions with a reduced content of polyunsaturated fatty acids, as compared to pure soy bean oil emulsions, and cover 40–50% of non-protein energy requirements [ 22 , 50 ].…”

“…Because fat is important in nutrient repletion of the malnourished patient, dietary fat should not be restricted unless true fat malabsorption has been diagnosed using a fecal fat test. Incorporating medium chain triglycerides; an alternative form of fat not requiring bile salts for absorption, can provide a concentrated source of calories to patients with fat malabsorption and are available in both EN and PN formulations [ 22 , 50 ].…”

“…However, Clinical essential fatty acid deficiency takes approximately 5 to 6 weeks to develop without linoleic acid or linolenic acid intake, so it is not likely to become an issue for most patients with liver failure except in those severely malnourished. Therefore, a short course of “fat-free” TPN might be used [ 22 , 51 ].…”

“…Moreover, patients with ESLD may have impaired synthesis of polyunsaturated fatty acids from their essential fatty acid precursors with increases in levels of n -6 and n -9 fatty acids and decreases in n -3 moieties in plasma and adipose tissue [ 21 ]. Enhanced gluconeogenesis, especially after fasting, with preference for fat metabolism, lipid peroxidation and lipolysis, also increases upon impaired glycogen storage and utilization [ 22 ].…”

Adipose Tissue Quantification by Imaging Methods: A Proposed Classification

“…This boundary does not include intermuscular and paravertebral adipose tissue, which should be included as nonvisceral adipose tissue. While, at present, the main imaging focus is on the total volume of adipose tissue structures, a growing interest centers on tissue quality. Chemical shift imaging can provide information on adipose tissue lipid content (38,39), and proton spectroscopy provides estimates of tissue‐free fatty acid composition (111). These advanced magnetic resonance methods have great promise in the field of obesity research.…”