Nature and quantity of fuels consumed in patients with alcoholic cirrhosis.

Abstract

A B S T R A C T Although alcoholism is a leading cause of morbidity and mortality of middle-aged Americans, there are no data available pertaining to the consequences of Laennec's cirrhosis on total body energy requirements or mechanisms for maintaining fuel homeostasis in this patient population. Therefore, we simultaneously used the techniques of indirect calorimetry and tracer analyses of ["4C]palmitate to measure the nature and quantity of fuels oxidized by patients with biopsy-proven alcoholic cirrhosis and compared the results with values obtained from healthy volunteers. Cirrhotic patients were studied after an overnight fast (10-12 h). Normal volunteers were studied after an overnight fast (12 h) or after a longer period of starvation (36-72 h).Total basal metabolic requirements were similar in overnight fasted cirrhotic patients (1.05±0.06 kcal/ min per 1.73 m2), overnight fasted normal subjects (1.00±0.05 kcal/min per 1.73 m2), and 36-72-h fasted normal volunteers (1.10±0.06 kcal/min per 1.73 m2).Indirect calorimetry revealed that in cirrhotic patients the percentages of total calories derived from fat (69±3%), carbohydrate (13±2%), and protein (17±4%) were comparable to those found in 36-72-h fasted subjects, but were clearly different from those of overnight fasted normal individuals who derived 40±6, 39±4, and 21±2% from fat, carbohydrate, and protein, respectively.These data are strikingly similar to data obtained through tracer analyses of ['4C]palmitate, which showed that in overnight fasted patients with alcoholic cir-

Resting energy expenditure should be measured in patients with cirrhosis, not predicted

“…Methodological variation, poor matching of control subjects, and referencing of data to body composition variables determined using unvalidated methods 61 limit the conclusions that can be drawn from other studies on REE in this patient population. [16][17][18][19][20][21][22] Nevertheless, the proportion of patients identified as hypo-and hypermetabolic in the present study are similar to those reported previously. 17,28,33,62 In our patients with cirrhosis, the Harris-Benedict, Schofield, Mifflin, and Owen formulae yielded mean predicted values for REE that significantly underestimated the mean measured value by 6%, 3%, 11%, and 7%, respectively, while the Cunningham formula significantly overestimated the mean measured value by 5%.…”

“…[12][13][14][15] However, there is no consensus in the data on energy expenditure, and thus energy requirements, in this patient population. [16][17][18][19][20][21][22] Plauth et al 23 recommended that energy requirements should be determined in patients with cirrhosis by measurement of their resting energy expenditure (REE) using indirect calorimetry. They suggest, but do not advocate, that if the facilities for measurement are not available, then energy expenditure could be estimated by use of the Harris-Benedict prediction formulae.…”

Resting Energy Expenditure and Substrate Metabolism in Chinese Patients with Acute or Chronic Hepatitis B or Liver Cirrhosis

“…Some studies have reported an increased resting metabolic rate in cirrhotic patients (6)(7)(8), while others have described a normal (9,10) or low rate (11). In part, this variation may be the result of different methods used for measuring and calculating energy expenditure.…”

Nutritional Status and Liver Transplantation

“…It is highly recommended to make the periods of starvation shorter, by dividing the daily energy intake in multiple meals during the day. In fact, it has been shown that after overnight fast, cirrhotic patients experience a metabolic state similar to that of healthy subjects after 3 days of fasting, 50 with an increased gluconeogenesis from amino acids and increased lipolysis. A late evening snack has been found to be beneficial in cirrhotic patients to compensate the overnight fasting period.…”