title: Effect of a late evening snack on outpatients with liver cirrhosis.
abstract: OBJECTIVE
  We have reported that one-week administration of a late evening snack (LES) improved not only malnutrition but also glucose intolerance in hospitalized patients with liver cirrhosis. Thus, we investigated whether long-term LES administration to outpatients for 3 months could reproduce the results obtained from hospitalized patients, especially improved glucose intolerance. If this treatment aggravated glucose intolerance, we tried to find any marker predicting this aggravation before the treatment.
  
  
  METHODS
  Outpatients were prescribed one pack of oral supplementation of a branched-chain amino acid (BCAA)-enriched nutrient, Aminoleban EN (210 kCal) as a LES without dietician supervision. Both before LES administration and after 3 months, glucose tolerance and liver function were examined using a 75 g oral glucose tolerance test (OGTT), biochemical parameters in blood and the relationship between glucose tolerance (area under the curve (AUC)) and the following serum markers.
  
  
  RESULTS
  Branched-chain amino acid/tyrosine ratio (BTR), the number of red blood cells (RBC), and hematocrit (Ht) significantly increased, with significant reduction of blood NH(3) level in patients with a blood glucose level less than 200 mg/dL 2 h after 75 g OGTT. However, the increase of AUC was seen after 3 months of LES administration in patients who had blood glucose higher than 200 mg/dL 2 h after 75 g OGTT. AUC weakly correlated positively with serum 7S collagen and negatively with choline esterase (ChE) and albumin (Alb).
  
  
  CONCLUSIONS
  75 g OGTT is a useful marker to predict the worst outcome and avoid the adverse effect of LES treatment in liver cirrhosis patients if performed without adequate nutrient conduct by a dietician.
authors.affiliation: Department of Gastroenterology and Hepatology, Graduate School of Medicine, Yamaguchi University, Ube, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Aoyama
authors.forename: Masako
authors.initials: M
authors.lastname: Tsuchiya
authors.forename: Kenji
authors.initials: K
authors.lastname: Mori
authors.forename: Yoshitsugu
authors.initials: Y
authors.lastname: Kubo
authors.forename: Kei
authors.initials: K
authors.lastname: Shiraishi
authors.forename: Eiki
authors.initials: E
authors.lastname: Sakaguchi
authors.forename: Satoyoshi
authors.initials: S
authors.lastname: Yamashita
authors.forename: Isao
authors.initials: I
authors.lastname: Sakaida