title: Factors related to increased resting energy expenditure in men with liver cirrhosis.
abstract: OBJECTIVE
  Hypermetabolism in cirrhosis is associated with a high risk of complications and mortality. However, studies about underlying mechanisms are usually focussed on isolated potential determinants and specific etiologies, with contradictory results. We aimed at investigating differences in nutrition, metabolic hormones, and hepatic function between hypermetabolic and nonhypermetabolic men with cirrhosis of the liver.
  
  
  METHODS
  We prospectively enrolled 48 male cirrhotic inpatients. We evaluated their resting energy expenditure (REE) and substrate utilization by indirect calorimetry, body composition by dual-energy X-ray absorptiometry, liver function, and levels of major hormones involved in energy metabolism by serum sample tests. Patients with ascites, specific metabolic disturbances, and hepatocellular carcinoma were excluded.
  
  
  RESULTS
  REE and REE adjusted per fat-free mass (FFM) were significantly increased in cirrhotic patients. Overall, 58.3% of cirrhotic patients were classified as hypermetabolic. Groups did not differ significantly in age, etiology of cirrhosis, liver function, presence of ascites, use of diuretics, β-blockers, or presence of transjugular intrahepatic portosystemic shunts. Hypermetabolic cirrhotic patients had lower weight, BMI (P<0.05), nonprotein respiratory quotient (P<0.01), leptin (P<0.05), and leptin adjusted per fat mass (FM) (P<0.05), but higher FFM% (P<0.05) and insulin resistance [homeostatic model assessment-insulin resistance (HOMA-IR)] (P<0.05). Only HOMA-IR, leptin/FM, and FFM% were independently related to the presence of hypermetabolism.
  
  
  CONCLUSIONS
  Hypermetabolic cirrhotic men are characterized by lower weight, higher FFM%, insulin resistance, and lower leptin/FM when compared with nonhypermetabolic men. HOMA-IR, FFM%, and leptin/FM were independently associated with hypermetabolism, and may serve as easily detectable markers of this condition in daily clinical practice.
authors.affiliation: aDepartment of Gastroenterology bLiver Unit, Department of Medicine cDepartment of Endocrinology dDepartment of Nuclear Medicine eDepartment of Laboratory Medicine, Clínica Universidad de Navarra fInstitute for Biomedical Research in Navarra (IDISNA), Pamplona gBiomedical Research Network in Liver and Digestive Diseases (CIBEREHD), Madrid, Spain.
authors.forename: César
authors.initials: C
authors.lastname: Prieto-Frías
authors.forename: Marian
authors.initials: M
authors.lastname: Conchillo
authors.forename: Marina
authors.initials: M
authors.lastname: Payeras
authors.forename: Mercedes
authors.initials: M
authors.lastname: Iñarrairaegui
authors.forename: Delia
authors.initials: D
authors.lastname: Davola
authors.forename: Gema
authors.initials: G
authors.lastname: Frühbeck
authors.forename: Javier
authors.initials: J
authors.lastname: Salvador
authors.forename: Macarena
authors.initials: M
authors.lastname: Rodríguez
authors.forename: José Á
authors.initials: JÁ
authors.lastname: Richter
authors.forename: Carmen
authors.initials: C
authors.lastname: Mugueta
authors.forename: María J
authors.initials: MJ
authors.lastname: Gil
authors.forename: Ignacio
authors.initials: I
authors.lastname: Herrero
authors.forename: Jesús
authors.initials: J
authors.lastname: Prieto
authors.forename: Bruno
authors.initials: B
authors.lastname: Sangro
authors.forename: Jorge
authors.initials: J
authors.lastname: Quiroga
mesh_terms: D015502:Absorptiometry, Photon; D000328:Adult; D001481:Basal Metabolism; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D001823:Body Composition; D001835:Body Weight; D002153:Calorimetry, Indirect; D016022:Case-Control Studies; D006801:Humans; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D020738:Leptin / Q000097:blood; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy; D008111:Liver Function Tests; D008297:Male; D008659:Metabolic Diseases / Q000175:diagnosis / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy; D008875:Middle Aged; D009752:Nutritional Status; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012146:Rest
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D007328:Insulin; D020738:Leptin