Journal
EUROPEAN JOURNAL OF CLINICAL NUTRITION
Volume 67, Issue 12, Pages 1251-1256Publisher
NATURE PUBLISHING GROUP
DOI: 10.1038/ejcn.2013.163
Keywords
acute-on-chronic liver failure; hepatitis b; energy expenditure; substrate oxidation; nutrition support
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Funding
- Foundation of Capital Medicine Development Committee [H020920020890]
- Foundation of Capital 20 Medicine Development Committee [H020920020890]
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BACKGROUND/OBJECTIVES: This study investigates the effects of a carbohydrate (CHO; lotus-root starch) predominant, late-evening snack (LES), containing 200 kcal (50 g CHO) on fasting resting energy expenditure (REE) and nutrient oxidation in hospitalized adults with acute-on-chronic liver failure (ACLF). SUBJECTS/METHODS: Adults with ACLF were randomized to receive daily LES (treatment; n=35) or standard care (n=35; non-supplemented control) for 14 days. REE and respiratory quotient (RQ) were measured by indirect calorimetry, nutrient oxidation (CHO, protein and fat), intake and biochemical parameters were measured in both groups at baseline and after 14 days using validated techniques. Disease severity was measured using the model for end-stage liver disease (MELD). RESULTS: No significant differences in macronutrient intake, anthropometric, demographic characteristics or MELD scores were observed between groups at baseline (P>0.05). Fasting RQ was significantly higher in the LES supplemented verses the control group after 2 weeks (P=0.02). CHO oxidation was significantly higher (P=0.001) and fat oxidation (P=0.02) was lower in the LES-supplemented group when compared with controls after 2 weeks. Fasting RQ and REE in the LES-supplemented group increased significantly (0.83 verses 0.88; P=0.007/1301 +/- 409 vs 1687 +/- 718 kcal/day; P = 0.02) in patients with MELD scores <= 30 when compared with patients with MELD scores >30 (0.82 verses 0.84; P=0.27/ 1361 +/- 405 vs 1437 +/- 429 kcal/day; P=0.67) after supplementation. CONCLUSIONS: 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.
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