Whole-body protein turnover in malnourished patients with child class B and C cirrhosis on diets low to high in protein energy.
The purpose of this study was to determine the rate of whole-body protein turnover in moderately and severely alcoholic, malnourished, cirrhotic patients fed with different amounts of protein or energy. Six male patients (Child classes B and C) and four age- and sex-matched healthy control subjects were studied for 18 d in fasting and feeding states; a single oral dose of [(15)N]glycine was used as a tracer and urinary ammonia was the end product. The kinetic study showed that patients had higher protein catabolism while fasting (patients: 3.14 +/- 1.2 g of lean body mass/9 h; controls: 1.8 +/- 0.3 g of lean body mass/9 h; P < 0.02). Although not statistically significant, protein catabolism (grams of lean body mass/9 h) was lower with the hyperproteic/hyperenergetic diet when compared with fasting. Nitrogen retention was consistent with the lower protein-catabolism rate; a statistically significant increase in nitrogen balance was observed when patients were fed with the hyperproteic/hyperenergetic diet compared with fasting (4.3 +/- 3.2 g of nitrogen/d and -2.2 +/- 1.9 g of nitrogen/d, respectively; P < 0.01). These data indicate that Child class B and C cirrhotic patients are hypercatabolic and that long-term nutritional intervention with a hyperproteic/hyperenergetic diet is likely needed to improve their clinical and nutritional status.
Dichi
J B
JB
Department of Internal Medicine, Londrina State University, Londrina, Paraná, Brazil. dichi@sercomtel.com.br
Dichi
I
I
Maio
R
R
Correa
C R
CR
Angeleli
A Y
AY
Bicudo
M H
MH
Rezende
T A
TA
Burini
R C
RC
D000328:Adult; D000641:Ammonia / Q000652:urine; D016022:Case-Control Studies; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake; D005215:Fasting; D005998:Glycine; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000378:metabolism; D009587:Nitrogen Isotopes; D009748:Nutrition Disorders / Q000150:complications / Q000378:metabolism*; D011506:Proteins / Q000378:metabolism*
D004044:Dietary Proteins; D009587:Nitrogen Isotopes; D011506:Proteins; D000641:Ammonia; D009584:Nitrogen; D005998:Glycine