Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: a randomized 12-month trial.
Patients with liver cirrhosis exhibit early onset of gluconeogenesis after short-term fasting. This accelerated metabolic reaction to starvation may underlie their increased protein requirements and muscle depletion. A randomized controlled trial was conducted to test the hypothesis that provision of a late-evening nutritional supplement over a 12-month period would improve body protein stores in patients with cirrhosis. A total of 103 patients (68 male, 35 female; median age 51, range 28-74; Child-Pugh grading: 52A, 31B, 20C) were randomized to receive either daytime (between 0900 and 1900 hours) or nighttime (between 2100 and 0700 hours) supplementary nutrition (710 kcal/day). Primary etiology of liver disease was chronic viral hepatitis (67), alcohol (15), cholestatic (6), and other (15). Total body protein (TBP) was measured by neutron activation analysis at baseline, 3, 6, and 12 months. Total daily energy and protein intakes were assessed at baseline and at 3 months by comprehensive dietary recall. As a percentage of values predicted when well, TBP at baseline was similar for the daytime (85 +/- 2[standard error of the mean]%) and nighttime (84 +/- 2%) groups. For the nighttime group, significant increases in TBP were measured at 3 (0.38 +/- 0.10 kg, P = 0.0004), 6 (0.48 +/- 0.13 kg, P = 0.0007), and 12 months (0.53 +/- 0.17 kg, P = 0.003) compared to baseline. For the daytime group, no significant changes in TBP were seen. Daily energy and protein intakes at 3 months were higher than at baseline in both groups (P < 0.0001), and these changes did not differ between the groups.


CONCLUSIONS
Provision of a nighttime feed to patients with cirrhosis results in body protein accretion equivalent to about 2 kg of lean tissue sustained over 12 months. This improved nutritional status may have important implications for the clinical course of these patients.
Plank
Lindsay D
LD
Department of Surgery, University of Auckland, Auckland, New Zealand. l.plank@auckland.ac.nz
Gane
Edward J
EJ
Peng
Szelin
S
Muthu
Carl
C
Mathur
Sachin
S
Gillanders
Lyn
L
McIlroy
Kerry
K
Donaghy
Anthony J
AJ
McCall
John L
JL
D000328:Adult; D000368:Aged; D002940:Circadian Rhythm; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D013006:Growth Hormone / Q000097:blood; D006801:Humans; D018972:Insulin-Like Growth Factor Binding Protein 3 / Q000097:blood; D007334:Insulin-Like Growth Factor I / Q000378:metabolism; D008103:Liver Cirrhosis / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009501:Neutron Activation Analysis; D009752:Nutritional Status; D018529:Nutritional Support; D011506:Proteins / Q000378:metabolism*; D011788:Quality of Life
D004044:Dietary Proteins; D018972:Insulin-Like Growth Factor Binding Protein 3; D011506:Proteins; D007334:Insulin-Like Growth Factor I; D013006:Growth Hormone