Effect of late night snack on nutritional status and quality of life in cirrhotic patients

Abstract

Objective To investigate the changes in energy metabolism, disease status and quality of life in liver cirrhosis patients after 3 months of nutrition intervention in the form of late night snack. Methods This study is a prospective, open-label, multicenter study with a total of 105 patients with HBV-related cirrhosis in 8 city and suburban hospital in Beijing. All the patients received the intervention of 836.4 kJ of late night snacks for 3 months. The nutritional status was evaluated with Nutritional Risk Screening 2002 (NRS 2002), Subjective Global Assessment, traditional nutrition index, metabolic cart, and WHOQOL-BREF questionnaire. We compared the nutritional status, liver function index, complications and quality of life of the patients before (baseline) and 3 months after the intervention. Results Child-Pugh A, B, C grade accounted for 60.00% (63/105), 31.43% (33/105), and 8.57% (9/105), respectively of the 105 patients with hepatitis B cirrhosis. 91 cases with albumin (ALB) >30 g/L were assessed using NRS2002, 37.36% (34/91) of whom had NRS 2002≥3.According to Subjective Global Assessment, the prevalence of malnutrition was 34.39% before and 10.47% after the intervention (P<0.05). Liver function indexes were significantly improved after intervention compared with the baseline: serum total protein (TP) [(66.59 ±8.73)g/L vs. (68.25± 7.89)g/L], albumin (ALB)[(38.52 ± 6.60)g/L vs. (39.82 ±5.79)g/L], pre albumin (PALB)[(1 519.70±690.40)mg/L vs. (1 731.10±651.10)mg/L], cholinesterase (CHE)[(5 273.17±2 358.85)U/L vs. (5 569.81 ±2 110.41)U/L], total cholesterol (TC)[(3.86±1.02)mmol/L vs.(4.03 ± 0.92)mmol/L] (all P<0.05). After the intervention, the proportion of Child-Pugh grade A patients increased from 60% to 72.38%, and the proportion of Child-Pugh grade C patients reduced from 8.57% to 1.90% (both P<0.05). In terms of complications, the prevalence of ascites (26.67% vs. 12.38%) and spontaneous bacterial peritonitis (10.48% vs. 1.90%) were reduced (both P<0.05). Compared with before the intervention, the quality of life of the patients was improved [(73.81±10.07) vs. (76.95±10.20), P<0.05]. Baseline and 3-month measurement of energy metabolism were completed in 46 patients: respiratory quotient (0.80±0.07 vs. 0.84±0.07) and carbohydrate oxidation rate [(41.93±11.33)% vs. (51.11±8.96)%] were significantly higher after intervention (both P<0.05), while protein oxidation rate [(22.13±4.34)% vs. (18.76±2.90)%] and fat oxidation rate [(35.93±11.01)% vs. (30.35±8.60)%] were significantly lower (both P<0.05). Conclusion The continuous intervention with 836.4 kJ of carbohydrates may reduce the decomposition of protein and fat in patients with cirrhosis, improve liver function, reduce complications, and improve patient quality of life. Key words: Liver cirrhosis; Nutritional support; Late night snack