title: Effect of a carbohydrate-containing late-evening snack on energy metabolism and fasting substrate utilization in adults with acute-on-chronic liver failure due to Hepatitis B.
abstract: OBJECTIVE
  This study investigates the effects of a carbohydrate (CHO; lotus-root starch) predominant, late-evening snack (LES), containing 200 kcal (50 g CHO) on fasting resting energy expenditure (REE) and nutrient oxidation in hospitalized adults with acute-on-chronic liver failure (ACLF).
  
  
  METHODS
  Adults with ACLF were randomized to receive daily LES (treatment; n=35) or standard care (n=35; non-supplemented control) for 14 days. REE and respiratory quotient (RQ) were measured by indirect calorimetry, nutrient oxidation (CHO, protein and fat), intake and biochemical parameters were measured in both groups at baseline and after 14 days using validated techniques. Disease severity was measured using the model for end-stage liver disease (MELD).
  
  
  RESULTS
  No significant differences in macronutrient intake, anthropometric, demographic characteristics or MELD scores were observed between groups at baseline (P>0.05). Fasting RQ was significantly higher in the LES supplemented verses the control group after 2 weeks (P=0.02). CHO oxidation was significantly higher (P=0.001) and fat oxidation (P=0.02) was lower in the LES-supplemented group when compared with controls after 2 weeks. Fasting RQ and REE in the LES-supplemented group increased significantly (0.83 verses 0.88; P=0.007/1301±409 vs 1687±718 kcal/day; P=0.02) in patients with MELD scores 30 when compared with patients with MELD scores >30 (0.82 verses 0.84; P=0.27/ 1361±405 vs 1437±429 kcal/day; P=0.67) after supplementation.
  
  
  CONCLUSIONS
  A carbohydrate-predominant LES is associated with increases in fasting carbohydrate oxidation, REE and reductions in fat oxidation in adults with ACLF. Therapeutic strategies utilizing LES may promote improved nutritional status in adults with ACLF.
authors.affiliation: Department of Hepatology, Beijing You An Hospital, Capital Medical University, Beijing, China.
authors.forename: W
authors.initials: W
authors.lastname: Hou
authors.forename: J
authors.initials: J
authors.lastname: Li
authors.forename: J
authors.initials: J
authors.lastname: Lu
authors.forename: J H
authors.initials: JH
authors.lastname: Wang
authors.forename: F Y
authors.initials: FY
authors.lastname: Zhang
authors.forename: H W
authors.initials: HW
authors.lastname: Yu
authors.forename: J
authors.initials: J
authors.lastname: Zhang
authors.forename: Q W
authors.initials: QW
authors.lastname: Yao
authors.forename: J
authors.initials: J
authors.lastname: Wu
authors.forename: S Y
authors.initials: SY
authors.lastname: Shi
authors.forename: D R
authors.initials: DR
authors.lastname: Mager
authors.forename: Q H
authors.initials: QH
authors.lastname: Meng
mesh_terms: D000328:Adult; D002681:China; D004032:Diet; D004040:Dietary Carbohydrates / Q000008:administration & dosage* / Q000378:metabolism; D004041:Dietary Fats / Q000378:metabolism; D058625:End Stage Liver Disease / Q000178:diet therapy* / Q000821:virology; D004734:Energy Metabolism; D005215:Fasting; D005260:Female; D006509:Hepatitis B / Q000150:complications*; D006801:Humans; D017114:Liver Failure, Acute / Q000178:diet therapy* / Q000821:virology; D008297:Male; D008875:Middle Aged; D044623:Nutrition Therapy; D010084:Oxidation-Reduction; D062410:Snacks
chemical_list: D004040:Dietary Carbohydrates; D004041:Dietary Fats