Effect of a carbohydrate-containing late-evening snack on energy metabolism and fasting substrate utilization in adults with acute-on-chronic liver failure due to Hepatitis B

Abstract

A carbohydrate-predominant LES is associated with increases in fasting carbohydrate oxidation, REE and reductions in fat oxidation in adults with ACLF. Therapeutic strategies utilizing LES may promote improved nutritional status in adults with ACLF.

Nutritional Therapy in Liver Transplantation

“…Some reports found that carbohydrate-predominant LES promote improved nutritional status [ 108 , 109 ]. Others reported that LES with BCAA were useful in improving protein metabolism and lipolysis in cirrhotic patients and that energy efficiency of BCAA is higher than that of glucose or carbohydrates [ 31 , 106 , 107 ].…”

“…The majority of the published studies reported a significant increase in dietary intake when the patients were followed after liver transplantation. These changes are particularly evident in those patients following severe dietary restrictions or in those suffering from relevant gastrointestinal symptoms or anorexia before LT [ 107 , 108 ]. Calories reportedly improved from a median of 27 kcal/kg/day to 32 kcal/kg/day and proteins from a median of 0.8 g/kg/day to 1.3 g/kg/day (comparing dietary intake before LT and 12 months post-transplant [ 73 ].…”

“…Energy expenditure normalized only when insulin sensitivity was restored. However, those patients with a reduced energy expenditure showed the higher increase in fat mass [ 107 , 108 , 109 ].…”

“…Non-protein energy requirements, in this period, vary according to the metabolic and inflammatory status, with unstable patients demanding lower intakes while the others more. When indirect calorimetry is not available, estimates between 25 and 30 kcal/kg/day maybe used [ 108 , 109 ].…”

“…Total body water decreases and body fat increases, whereas BCM remains unchanged after LT [ 107 ]. Deficiencies in vitamin A and zinc immediately normalize after LT [ 108 , 109 ]. Increased REE may persist for a long period after LT [ 108 , 112 ]; however, overweight status and hypercholesterolemia have been observed after LT [ 110 , 111 ], accompanied by an increase in the saturated fatty acid content of fat tissue [ 109 , 113 ].…”