Body composition changes after transjugular intrahepatic portosystemic shunt in patients with cirrhosis.
OBJECTIVE
To investigate the effect of transjugular intrahepatic porto-systemic shunt (TIPS) on malnutrition in portal hypertensive cirrhotic patients.


METHODS
Twenty-one patients with liver cirrhosis and clinical indications for TIPS insertion were investigated before and 1, 4, 12, 52 wk after TIPS. For each patient we assayed body composition parameters [dry lean mass, fat mass, total body water (TBW)], routine liver and kidney function tests, and free fatty acids (FFA). Glucose and insulin were measured for the calculation of the homeostasis model assessment insulin resistance (HOMA-IR); liver function was measured by the galactose elimination capacity (GEC); the severity of liver disease was graded by model for end-stage liver disease (MELD).


RESULTS
Porto-systemic gradient decreased after TIPS (6.0 +/- 2.1 mmHg vs 15.8 +/- 4.8 mmHg, P < 0.001). Patients were divided in two groups according to initial body mass index. After TIPS, normal weight patients had an increase in dry lean mass (from 10.9 +/- 5.9 kg to 12.7 +/- 5.6 kg, P = 0.031) and TBW (from 34.5 +/- 7.6 L to 40.2 +/- 10.8 L, P = 0.007), as well as insulin (from 88.9 +/- 49.2 pmol/L to 164.7 +/- 107.0 pmol/L, P = 0.009) and HOMA-IR (from 3.36% +/- 2.18% to 6.18% +/- 4.82%, P = 0.023). In overweight patients only FFA increased significantly (from 0.59 +/- 0.24 mmol/L to 0.93 +/- 0.34 mmol/L, P = 0.023).


CONCLUSIONS
TIPS procedure is effective in lowering portal pressure in patients with portal hypertension and improves body composition without significant changes in metabolic parameters.
Montomoli
Jonathan
J
Department of Internal Medicine, Aging and Nephrological Diseases, University of Bologna S. Orsola-Malpighi Hospital, Via Albertoni 15, I-40138 Bologna, Italy.
Holland-Fischer
Peter
P
Bianchi
Giampaolo
G
Grønbaek
Henning
H
Vilstrup
Hendrik
H
Marchesini
Giulio
G
Zoli
Marco
M
D001786:Blood Glucose / Q000378:metabolism; D001823:Body Composition / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000503:physiopathology / Q000601:surgery; D007328:Insulin / Q000097:blood; D008103:Liver Cirrhosis / Q000150:complications / Q000503:physiopathology* / Q000601:surgery*; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D009752:Nutritional Status / Q000502:physiology; D019168:Portasystemic Shunt, Transjugular Intrahepatic; D011446:Prospective Studies
D001786:Blood Glucose; D007328:Insulin