Nutritional support in alcoholic cirrhotic patients improves host defenses.
BACKGROUND
Malnutrition is usual in patients with alcoholic liver disease and is associated with a poor outcome. Nutritional support decreases nutrition-associated complications.


OBJECTIVE
To demonstrate that nutritional support in ambulatory alcoholic cirrhotic patients improves host defenses.


METHODS
Thirty-one male outpatients with alcoholic cirrhosis CHILD-PUGH B or C were included. Twenty-five subjects completed six months consuming daily a nutritional supplement (Ensure, 1000 Kcal and 35 g protein), in addition to their regular diet. At entrance and every three months, a clinical assessment, nutritional evaluation and indirect calorimetry were performed. Liver function tests and LPS-induced monocyte production of cytokines, salivary secretory IgA, lactulose/mannitol ratio and breath hydrogen tests were also measured in these intervals. Delayed cutaneous hypersensitivity and IgG and IgM antibody response to endotoxin were assessed at entrance and at the end of the study.


RESULTS
Patients drank 85% of the provided supplement as an average. REE, total body fat and serum albumin increased, basal breath hydrogen decreased and cellular immunity improved significantly during the follow up period (p< or =0.03). All the other parameters remained unchanged throughout the study. Six patients (16.2%) died during the study, five due to upper gastrointestinal bleeding.


CONCLUSIONS
Nutritional support in alcoholic cirrhotic patients improves nutritional status and cell mediated immunity.
Hirsch
S
S
Institute of Nutrition and Food Technology, University of Chile, Santiago.
de la Maza
M P
MP
Gattás
V
V
Barrera
G
G
Petermann
M
M
Gotteland
M
M
Muñoz
C
C
Lopez
M
M
Bunout
D
D
D000273:Adipose Tissue; D000328:Adult; D000368:Aged; D001823:Body Composition; D001944:Breath Tests; D019422:Dietary Sucrose; D004734:Energy Metabolism; D005526:Food, Formulated; D006801:Humans; D006859:Hydrogen / Q000032:analysis; D007111:Immunity, Cellular; D015850:Interleukin-6 / Q000096:biosynthesis; D007963:Leukocytes, Mononuclear / Q000276:immunology; D008070:Lipopolysaccharides / Q000494:pharmacology; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000276:immunology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009748:Nutrition Disorders / Q000150:complications / Q000628:therapy; D018529:Nutritional Support; D012709:Serum Albumin / Q000032:analysis
D019422:Dietary Sucrose; D015850:Interleukin-6; D008070:Lipopolysaccharides; D012709:Serum Albumin; C082131:Ensure formulated food; D006859:Hydrogen