Total and individual free fatty acid concentrations in liver cirrhosis

Abstract

The finding of high plasma free fatty acid (FFA) levels in cirrhotic patients has been attributed either to decreased hepatic clearance or to enhanced fat mobilization. To better clarify these hypotheses, total and individual FFA and glycerol levels were determined in 21 cirrhotic patients with different degrees of hepatocellular damage (evaluated by liver function tests), portal hypertension (evaluated by endoscopy and clinical signes), and nutritional status (evaluated by anthropometric and biohumoral parameters) and in 10 age- and sex-matched healthy subjects. Glucose tolerance and insulin and glucagon levels were determined in all individuals. Well-nourished and malnourished patients were identified within the cirrhotic group. Plasma FFA and glycerol concentrations were well correlated (r = 0.47, P < 0.05), levels being significantly higher in cirrhotic individuals than in controls (746.6 ± 46.29 SE v 359.22 ± 40.82 μmol/L, P < 0.001 for plasma FFA; 150.1 ± 3.12 v 82.5 ± 9.2 μmol/L, P < 0.01) for glycerol). Plasma FFA and glycerol showed no correlation with the liver function test results or portal hypertension parameters. Interestingly, plasma levels of FFA and glycerol were influenced by the nutritional status, significantly higher FFA levels being observed in the well-nourished than in the malnourished patients (842.5 ± 47.5 v 563.4 ± 78 μmol/L, P < 0.005). Furthermore, a positive correlation was found between plasma glycerol level and percentage of triceps skinfold ( r = 0.45, P < 0.05). No correlation was found between plasma levels of FFA or glycerol and glucose tolerance, insulin and glucagon. So far the individual FFA patterns are concerned, a significant percentage decrease was observed in palmitic and stearic acid levels and a significant percentage increase in palmitoleic and oleic acid levels in the cirrhotic group, no difference being found between well-nourished and malnourished patients. In conclusion, the high plasma FFA and glycerol levels in patients with liver cirrhosis do not appear to depend on the degree of liver damage or portal hypertension, but rather are due to enhanced lipolysis. Fat mobilization appears to decrease as malnutrition advances.