Resting energy expenditure in diabetic and nondiabetic patients with liver cirrhosis: relation with insulin sensitivity and effect of liver transplantation and immunosuppressive therapy.
BACKGROUND
Hypermetabolism, insulin resistance, and diabetes are common in patients with liver cirrhosis.


OBJECTIVE
We assessed whether diabetes and insulin resistance influence postabsorptive energy homeostasis in these patients and whether liver transplantation (LTx) and immunosuppressive drugs affect these relations.


METHODS
Twenty-six patients with liver cirrhosis (16 with and 10 without diabetes) were studied with an insulin clamp and indirect calorimetry. Eleven of these subjects were studied 9 mo after LTx to longitudinally assess its effects. To cross-sectionally explore a longer follow-up period, we studied 65 patients 6, 14, and 32 mo after LTx. Seven patients with chronic uveitis (receiving immunosuppressive therapy) and 20 healthy subjects served as control subjects.


RESULTS
Diabetic and nondiabetic patients with cirrhosis had insulin resistance (S(I(clamp)); P < 0.03) and higher measured resting energy expenditure (REE) as a percentage of predicted REE than did healthy subjects (107.6 +/- 1.8% compared with 97.4 +/- 2.3%; P < 0.03), and these 2 alterations were associated (R(2) = 0.119, P = 0.0002). The longitudinal study showed an improvement in the 2 variables after LTx, but full restoration was not achieved. The cross-sectional analysis confirmed this observation in patients studied 6 mo (n = 28) after LTx. In patients studied 14 (n = 21) and 32 mo (n = 16) after LTx, S(I(clamp)) and measured REE as a percentage of predicted REE were not significantly different from those in control subjects.


CONCLUSIONS
In patients with liver cirrhosis, higher-than-normal postabsorptive REE was associated with insulin resistance regardless of diabetes. This abnormality persisted in patients studied 6-9 mo after LTx but improved simultaneously with the improvement in insulin sensitivity thereafter.
Division of Internal Medicine, Istituto H San Raffaele, Milan, Italy. perseghin.gianluca@hsr.it
Gianluca
G
Perseghin
Vincenzo
V
Mazzaferro
Stefano
S
Benedini
Andrea
A
Pulvirenti
Jorgelina
J
Coppa
Enrico
E
Regalia
Livio
L
Luzi
D001481:Basal Metabolism; D002153:Calorimetry, Indirect; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000378:metabolism*; D004734:Energy Metabolism; D005502:Food; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism* / Q000601:surgery; D016031:Liver Transplantation; D008137:Longitudinal Studies; D008875:Middle Aged; D010084:Oxidation-Reduction; D012044:Regression Analysis
D007166:Immunosuppressive Agents; D007328:Insulin