Hyper- and hypometabolism are not related to nutritional status of patients on the waiting list for liver transplantation.
OBJECTIVE
Metabolic disorders and malnutrition are well known conditions reported in patients with liver disease (LD), but the relationship between them are underexplored. So, the aim of this study was to assess the resting energy expenditure (REE) of these patients, identifying the prevalence of hyper- and hypometabolism. In addition, to evaluate whether malnutrition and clinical variables were associated with REE and metabolic disorders.


METHODS
The REE was measured by indirect calorimetry and predicted by the Harris and Benedict formula (REEHB). Nutritional status was assessed by different methods. The etiology, severity and complications of LD were also evaluated.


RESULTS
A total of 81 patients were assessed. The measured REE was 1587.5 ± 426.6 kcal. The REE was overestimated by the REEHB (REE:REEHB <0.8) in 7.4% and underestimated (REE:REEHB >1.2) in 24.7% of the patients. The REE was lower in malnourished patients (p < 0.05). However, hyper- and hypometabolism were not associated with nutritional status (p > 0.05). The REE and hypermetabolism were not associated with LD, but hypometabolic patients had a higher prevalence of Child C, and had higher values for MELD, INR and total bilirubin (p < 0.05). After multiple regression analyses, the REE was significantly associated (p < 0.05) with intracellular body water, arm muscle area and serum glucose. Serum glucose was only significantly associated (p < 0.05) with hypermetabolism, and INR with hypometabolism.


CONCLUSIONS
Changes in resting metabolism are present but not universal. The hypermetabolism was associated with extrahepatic factors, and hypometabolism with the severity of LD. Under these conditions in the clinical setting, calculated energy requirements using the HB formula should be adjusted.
Surgery Postgraduate Program, Medical School, Universidade Federal de Minas Gerais, Brazil. Electronic address: liviagf@gmail.com.
Lívia Garcia
LG
Ferreira
Nutrition Course, Nursing School, Universidade Federal de Minas Gerais, Brazil.
Laís Ferreira
LF
Santos
Nutrition Course, Nursing School, Universidade Federal de Minas Gerais, Brazil.
Thayná Ribeiro Neri da
TR
Silva
Adult Health Postgraduate Program, Medical School, Universidade Federal de Minas Gerais, Brazil.
Lucilene Rezende
LR
Anastácio
Surgery Postgraduate Program, Medical School, Universidade Federal de Minas Gerais, Brazil; Alfa Institute of Gastroenterology, Hospital of Clinics, Medical School, Universidade Federal de Minas Gerais, Brazil.
Agnaldo Soares
AS
Lima
Surgery Postgraduate Program, Medical School, Universidade Federal de Minas Gerais, Brazil; Alfa Institute of Gastroenterology, Hospital of Clinics, Medical School, Universidade Federal de Minas Gerais, Brazil.
Maria Isabel Toulson Davisson
MI
Correia
D000328:Adult; D000368:Aged; D001481:Basal Metabolism; D002153:Calorimetry, Indirect; D003430:Cross-Sectional Studies; D002149:Energy Intake; D005260:Female; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000503:physiopathology*; D016031:Liver Transplantation; D008297:Male; D044342:Malnutrition / Q000150:complications / Q000503:physiopathology; D008659:Metabolic Diseases / Q000150:complications / Q000503:physiopathology*; D008875:Middle Aged; D015999:Multivariate Analysis; D015596:Nutrition Assessment; D009751:Nutritional Requirements; D009752:Nutritional Status; D014850:Waiting Lists; D055815:Young Adult
Energy metabolism; Liver transplantation; Malnutrition