Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-19T10:50:22.442Z Has data issue: false hasContentIssue false
  • English
  • Français

One-month regular oral nutrition in alcoholic cirrhotic patients. Changes of nutritional status, hepatic function and serum lipid pattern

Published online by Cambridge University Press:  09 March 2007

Phoung Nhi Broies  and
Bernard Campillo
Phoung Nhi Broies
Affiliation:
Laboratoire Central Hôpital Albert Chenevier, Créteil, France
Bernard Campillo
Affiliation:
Service dé Hépato-gastroentárologie et Rééducation Digestive, Hôpital Albert Chenevier, Créteil, France
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The effect of a regular oral diet supplying 167 kJ/kg per d (40 kcal/kg per d) on nutritional state, liver function and serum lipid profile was assessed in thirty severely malnourished alcoholic cirrhotic in-patients. Their diet was monitored by a trained dietitian and they were vigorously encouraged to eat all meals served. One month after their entry into the study, protein and energy intakes were significantly higher (P 0·001) in keeping with an improvement of their nutritional status as evaluated by means of height-creatinine index, muscular mid-arm circumference, tricipital skinfold thickness (P 0·01 for all) and fat mass (P 0·001). Assessment of liver function tests showed that levels of aspartate amino-transferase (EC 2.6.1.1), y-glutamyl transferase (EC 2.3.2.2) and bilirubin decreased (P <0·05, P > 0·02 and P > 0·05 respectively) while prothrombin time values increased (P < 0·05). Similarly, serum albumin increased modestly while transthyretin did not change. Orosomucoid and C-reactive protein decreased (P < 0·001 and P < 0·01 respectively), indicating an improvement of the inflammatory state. Apolipoprotein Al and high-density-lipoprotein (HDL)-cholesterol correlated with several tests of liver function and improved significantly during the study period (P < 0·001 and P < 0·02 respectively). Moreover, changes in cholesterol and HDL-cholesterol correlated with those in transthyretin (P < 0·02 and P < 0·05 respectively). The changes in ApoAl and HDL-cholesterol were greater in patients whose fat mass increased significantly. Our findings show that adequate oral nutrition resulted in a better nutritional status in cirrhotics after 1 month of hospitalization. The serum lipid variables appeared to be more useful indicators of functional liver improvement than the classic liver function tests which rather indicate liver damage.

Keywords

Alcoholic cirrhosisOral dietNutritional statusLiver function
Type
Oral nutrition of cirrhotic patients
Information
British Journal of Nutrition , Volume 72 , Issue 6 , December 1994 , pp. 937 - 946
Copyright
Copyright © The Nutrition Society 1994

References

RERERENCES

Bishop, C. W., Bowen, P. E. & Ritchey, S. J. (1981). Norms for nutritional assessment of American adults by upper arm anthropometry. American Journal of Clinical Nutrition 34, 2530–2539.CrossRefGoogle ScholarPubMed
Bistrian, B. R., Blackburn, G. L., Sherman, M. & Scrimshaw, N. S. (1975). Therapeutic index of nutritional depletion in hospitalized patients. Surgery, Gynecology and Obstetrics 141, 512–516.Google ScholarPubMed
Cabre, E., Gonzalez-Huix, A., Abad-Lacruz, A., Esteve, M., Accro, D., Fernandez-Banares, F., Xiol, X. & Gassull, M. A. (1990). Effect of total enteral nutrition on the short-term outcome of severely malnourished cirrhotics. Gastroenterology 98, 715–720.CrossRefGoogle ScholarPubMed
Christie, M. L., Sack, D. M., Pomposelli, J. & Horst, D. (1985). Enriched branched-chain amino acid formula versus a casein-based supplement in the treatment of cirrhosis. Journal of Parenteral and Enteral Nutrition 9, 671–678.CrossRefGoogle ScholarPubMed
Cordova, C., Musca, A., Violi, F., Alessandri, C. & Iuliano, L. (1984). Apolipoprotein AI, AII and B in chronic active hepatitis and liver cirrhotic patients. Clinica Chimica Acta 137, 61–66.CrossRefGoogle Scholar
Duhamel, G., Nalpas, B., Goldstein, S., Laplaud, M., Berthelot, P. & Chapman, J. (1984). Plasma lipoprotein and apolipoprotein profile in alcoholic patients with and without liver disease: on the relative roles of alcohol and liver injury. Hepatology 4, 517–585.CrossRefGoogle ScholarPubMed
Durnin, J. V. G. & Womersley, A. J. (1974). Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 years. British Journal of Nutrition 32, 77–97.CrossRefGoogle ScholarPubMed
Edelstein, C., Gordon, J. I., Toscas, K., Sims, H. F., Strauss, A. W. & Scanu, A. M. (1983). In vitro conversion of proapoprotein A-I to apoprotein A-I. Journal of Biological Chemistry 258, 11430–11433. Heinrich, P. C., Castell, J. V. & Andus, T. (1990). Interleukin-6 and the acute phase response. Biochemical Journal 265, 621–636.Google Scholar
Hirsch, S., Bunout, D., de la Maza, P., Iturriaga, H., Petermann, M., Icazar, G., Gattas, V. & Ugarte, G. (1993). Controlled trial on nutrition supplementation in outpatients with symptomatic alcoholic cirrhosis. Journal of Parenteral and Enteral Nutrition 17, 119–124.CrossRefGoogle ScholarPubMed
Kanel, G. C., Radvan, G. & Peters, R. L. (1983). High-density lipoprotein cholesterol and liver disease. Hepatology 3, 343–348.CrossRefGoogle ScholarPubMed
Kearns, P. J., Young, H., Garcia, G., Blaschke, T., O'Hanlon, G., Rinki, M., Sucher, K. & Gregory, P. (1992). Accelerated improvement of alcoholic liver disease with enteral nutrition. Gastroenterology 102, 200–205.CrossRefGoogle ScholarPubMed
Keohane, P. P., Attrill, H., Grimble, G., Spiller, R., Frost, P. & Silk, D. B. A. (1983). Enteral nutrition in malnourished patients with hepatic cirrhosis and acute encephalopathy. Journal of Parenteral and Enteral Nutrition 7, 346–350.CrossRefGoogle ScholarPubMed
Kushner, I. (1988). The acute phase response: an overview. Methods in Enzymology 163, 373–383.CrossRefGoogle ScholarPubMed
Lautz, H. U., Selberg, O., Körberg, J., Bürger, M. & Müller, M. J. (1992). Protein–calorie malnutrition in liver cirrhosis. Clinical Investigator 70, 478–486.CrossRefGoogle ScholarPubMed
Lopes-Virella, M. F., Stone, P., Ellis, S. & Caldwell, J. A. (1977). Cholesterol determination in high-density lipoproteins separated by three different methods. Clinical Chemistry 23, 882–884.CrossRefGoogle ScholarPubMed
Malmendier, C. L., Lontie, J. F., Mathé, D., Adam, R. & Bismuth, H. (1992). Lipid and apolipoprotein changes after orthotopic liver transplantation for end-stage liver diseases. Clinica Chimica Acta 209, 169–177.CrossRefGoogle ScholarPubMed
Mendenhall, C. L., Tosch, T., Weesner, R. E., Garcia-Pont, P., Goldberg, S. J., Kiernan, T., Seef, L. B., Sorrell, M., Tamburro, C., Zetterman, R., Chedid, A., Chen, T. & Rabin, L. (1986). VA cooperative study on alcoholic hepatitis. II. Prognostic significance of protein-calorie malnutrition. American Journal of Clinical Nutrition 43, 213–218.CrossRefGoogle Scholar
Mezey, E., Caballeria, J., Mitchell, M. C., Pares, A., Herlong, H. Franklin & Rodes, J (1991). Effect of parenteral amino acid supplementation on short-term and long-term outcomes in severe alcoholic hepatitis: a randomized controlled trial. Hepatology 14, 1090–1096.CrossRefGoogle ScholarPubMed
Naveau, S., Pelletier, G., Poynard, T., Attali, P., Poitrine, A., Buffet, C., Etienne, J. P. & Chaput, J. C. (1986). A randomized clinical trial of supplementary parenteral nutrition in jaundiced alcoholic cirrhotic patients. Hepatology 6, 270–274.CrossRefGoogle ScholarPubMed
Nestel, P. J., Tada, N. & Fidge, N. H. (1980). Increased catabolism of high density lipoprotein in alcoholic hepatitis. Metabolism 29, 101–104.CrossRefGoogle ScholarPubMed
Ostrowski, Z. L. (1978). Les Aliments. Table des Valeurs Nutritives. Lanore, J.ed. Paris.Google Scholar
Poynard, T., Abella, A., Pignon, J. P., Naveau, S., Leluc, R. & Chaput, J. C. (1986). Apolipoprotein AI and alcoholic liver disease. Hepatology 6, 1391–1395.CrossRefGoogle ScholarPubMed
Pugh, R. N. H., Murray-Lyon, I. M., Dawson, J. L., Pietroni, M. C. & Williams, R. (1973). Transection of the oesophagus for bleeding oesophageal varices. British Journal of Surgery 60, 646–649.CrossRefGoogle ScholarPubMed
Rubies-Prat, J., Masdeu, S., Nubiola, A. R., Chacón, P., Holguera, C. & Masana, L. (1982). High-density lipoprotein cholesterol and phospholipids, and apoprotein A in serum of patients with liver disease. Clinical Chemistry 28, 525–527.CrossRefGoogle ScholarPubMed
Silk, D. B. A. (1988). Parenteral nutrition in patients with liver disease. Journal of Hepatology 7, 269–277.CrossRefGoogle ScholarPubMed
Smith, J., Horowitz, J., Henderson, J. M. & Heymsfield, S. (1982). Enteral hyperalimentation in undernourished patients with cirrhosis and ascites. American Journal of Clinical Nutrition 35, 56–72. Suehiro, T., Yamamoto, M., Yoshida, K. & Ohno, F. (1993). Increase of plasma proapolipoprotein A-I in patients with liver cirrhosis and its relationship to circulating high-density lipoproteins 2 and 3. Clinical Chemistry 39, 60–65.Google Scholar
Tateossian, S., Peynet, J. G., Legrand, A. G., Collet, B., Rossignol, J., Delattre, J. & Rousselet, F. (1985). Variations in HDL and VLDL levels in chronic alcoholics. Influence of the degree of liver damage and of withdrawal of alcohol. Clinica Chimica Acta 148, 211–219.CrossRefGoogle ScholarPubMed
Zannis, V. I., Karathanasis, S. K., Keutmann, H. T., Goldberger, G. & Breslow, J. L. (1983). Intracellular and extracellular processing of human apolipoprotein A-I: secreted apolipoprotein A-I isoprotein 2 is a propeptide. Proceedings of the National Academy of Sciences of the United States of America 80, 2574–2578.CrossRefGoogle ScholarPubMed