Malnutrition In Cirrhotic Patients Research Articles

Altered intestinal transport of amino acids in cirrhotic rats: the effect of insulin-like growth factor-I.

The intestine is an important target organ for insulin-like growth factor-I (IGF-I), an anabolic hormone synthesized in the liver upon growth hormone (GH) stimulation. Levels of IGF-I are reduced in cirrhosis, and altered GH/IGF-I axis may contribute to malnutrition in cirrhotic patients. Our aim was to study Na(+)-dependent jejunal transport of amino acids (L-leucine, L-proline, L-glutamic acid, and L-cysteine) in cirrhotic rats and to analyze the effect of IGF-I on this function. IGF-I or saline was administered for 2 wk to rats with CCl(4)-induced cirrhosis and saline was administered to healthy control rats. Transport of amino acids was assessed in brush-border membrane vesicles (BBMV) using (14)C- or (35)S-labeled amino acids, and the kinetic constants V(max) and K(t) were determined. Na(+)-independent uptake of L-leucine, L-proline, L-glutamic acid, and L-cysteine by BBMV was similar in all groups. Na(+)-dependent uptake of all four amino acids was significantly diminished in cirrhotic rats compared with both controls and IGF-I-treated cirrhotic rats. The latter two groups exhibited similar V(max) and K(t), whereas untreated cirrhotic rats had reduced V(max) and increased K(t) compared with normal controls and IGF-I-treated cirrhotic animals. In conclusion, the transport of all four tested amino acids by BBMV is impaired in cirrhotic rats, and low doses of IGF-I can correct this defect.

Nutritional and prognostic significance of insulin-like growth factor 1 in patients with liver cirrhosis

Most of the traditional parameters for nutrition assessment have important limitations in patients with chronic liver disease. Insulin-like growth factor 1 (IGF-1) has been found to be regulated by nutrition and proposed as a nutritional marker. Its nutritional significance in patients with liver cirrhosis, however, has not been investigated. Serum IGF-1 as well as traditional anthropometric, visceral, and immunologic parameters were evaluated in 64 hospitalized cirrhotics, followed up clinically for 2 y. IGF-1 z-score averaged −2.16 ± 1.08 and inversely correlated with Child-Pugh score ( P < 0.01), the most reliable composite score reflecting the severity of liver disease. IGF-1 z-score was not different in patients with or without signs of energy malnutrition, as defined by values of midarm muscle circumference (MAMC) and/or triceps skinfold (TSF) <5th percentile. Moreover, IGF-1 z-score did not correlate with MAMC or TSF. Despite its correlation with all visceral proteins, the reduction of IGF-1 was much greater and more frequent than that of visceral proteins. Patients with IGF-1 z-score < median values (−2.5) showed lower long-term survival rates compared with patients with IGF-1 z-score > −2.5 ( P < 0.01). These data indicate that serum IGF-1 is not related to energy malnutrition in cirrhotic patients, while it appears to be a good predictor of survival and an early marker of liver dysfunction. Multiple factors, most of which are related to the severity of the liver disease, may contribute to the reduction of IGF-1. This multifactorial pathogenesis probably accounts for its prognostic significance.

Malnutrition in cirrhotic patients: anthropometric measurements as a method of assessing nutritional status

SummaryThis study was undertaken to evaluate by anthropmetric measurements the nutritional status of cirrhotic patients at different stages of the disease and to establish intra‐ and inter‐observer variability in the determination of these parameters.In 60 healthy controls and 108 cirrhotics (63 ‘well compensated’ and 45 ‘decompensated’; groups A and B+C on the Child‐Pugh classification respectively) two independent experienced observers measured biceps, triceps, subscapular and overiliac skinfold thicknesses and arm circumference three times. Each observer was unaware of the results obtained by the other.No significant intra‐ or inter‐observer variability was found.The study indicates that skinfold thickness measurements are a reliable and reproducible method of assessing the nutritional status of cirrhotics. It was found that more than 50 per cent of the decompensated patients were malnourished, with skinfold values significantly lower than those of the controls.In comparison with skinfold thickness and arm circumference, parameters such as body weight and lean body mass are unreliable, and other indices such as muscle and/or fat arm area do not add any significant information to the evaluation of the nutritional status of cirrhotics.

Portacaval shunt, nutritional status and immunocompetence in the cirrhotic patient: Results of a prospective study

Twenty-four patients with cirrhosis were investigated. A nutritional study and an assessment of cellular immunity were performed prior to portacaval shunt and 2 months, 6 months and 12 months following this procedure. Serum bilirubin concentration and coagulation factors II and V were also measured. Following portacaval shunting, there was a progressive and significant increase of arm muscle circumference ( P < 0.001) and serum albumin concentration ( P < 0.001) as well as an improvement in delayed hypersensitivity and an increase of peripheral T lymphocytes. Serum bilirubin concentration significantly increased and coagulation factors significantly decreased. Among the 20 patients with alcoholic cirrhosis, 19 stopped drinking: 17 of them markedly improved their nutritional and immunological parameters whereas two remained unchanged. One patient pursued a heavy alcohol intake and his parameters deteriorated. The four patients with non alcoholic cirrhosis had mild malnutrition prior to portal systemic shunt which was not significantly altered by this procedure. These results suggest that: a) portacaval shunt does not aggravate the pre-existing malnutrition in cirrhotic patients; b) there is no relationship between the variations of nutritional status and that of liver function; c) improvement of the nutritional status observed in alcoholics following portal diversion is most likely related to alcohol abstinence.