title: Effect of paracentesis on metabolic activity in patients with advanced cirrhosis and ascites.
abstract: OBJECTIVE
  Patients with decompensated cirrhosis often suffer from malnutrition. To enable appropriate nutritional supplementation a correct estimation of resting energy expenditure (REE) is needed. It is, however, unclear whether the volume of ascites should be included or not in the calculations of the REE.
  
  
  METHODS
  In 19 patients with cirrhosis and ascites, measurements of REE by indirect calorimetry were performed before paracentesis, after paracentesis, and four weeks after paracentesis. Moreover, handgrip strength (HGS), dual X-ray absorptiometry (DXA), and biochemistry were assessed.
  
  
  RESULTS
  Calculated and measured REE differed more than 10% in 63% of the patients at baseline. By including the weight of ascites in the calculation of REE, the REE was overestimated by 283 (-602-1381) kJ/day (p = 0.69). By subtracting the weight of ascites in the calculation of REE, it was underestimated by -379 (-1915 - 219) kJ/day, (p  = 0.06). Patients in whom measured REE decreased after paracentesis had higher middle arterial pressure (MAP) (p = 0.02) and p-sodium (p = 0.02) at baseline. Low HGS (M: <30 kg; W < 20 kg) was evident in 68% of the patients. T-scores revealed osteopenia and osteoporosis in 58% and 16%, respectively. Reduced vitamin D levels (<50 nmol/l) were found in 68%.
  
  
  CONCLUSIONS
  The presence of ascites seems to increase REE, why we suggest that when REE is calculated, the weight of ascites should be included. Indirect calorimetry is, however, preferable for REE estimation. More than two-third of patients with ascites suffer from muscle weakness and/or osteopenia.
authors.affiliation: a Gastrounit, Medical Division , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;
authors.forename: Anne Wilkens
authors.initials: AW
authors.lastname: Knudsen
authors.affiliation: b Department of Gastroenterology and Hepatology , Odense University Hospital, University of Southern Denmark , Odense , Denmark ;
authors.forename: Aleksander
authors.initials: A
authors.lastname: Krag
authors.affiliation: a Gastrounit, Medical Division , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;
authors.forename: Inge
authors.initials: I
authors.lastname: Nordgaard-Lassen
authors.affiliation: c Department of Diagnostics, Clinical Physiology and Nuclear Medicine Section , Copenhagen University Hospital Glostrup , Glostrup , Denmark ;
authors.forename: Erik
authors.initials: E
authors.lastname: Frandsen
authors.affiliation: a Gastrounit, Medical Division , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;
authors.forename: Flemming
authors.initials: F
authors.lastname: Tofteng
authors.affiliation: a Gastrounit, Medical Division , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;
authors.forename: Christian
authors.initials: C
authors.lastname: Mortensen
authors.affiliation: a Gastrounit, Medical Division , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ;|d National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
authors.forename: Ulrik
authors.initials: U
authors.lastname: Becker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001201:Ascites / Q000150:complications* / Q000378:metabolism / Q000628:therapy; D002153:Calorimetry, Indirect; D004734:Energy Metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000378:metabolism / Q000628:therapy; D008297:Male; D044342:Malnutrition / Q000209:etiology / Q000378:metabolism / Q000628:therapy*; D008875:Middle Aged; D019152:Paracentesis; D012189:Retrospective Studies; D055815:Young Adult
keywords: Ascites; cirrhosis; indirect calorimetry; malnutrition; nutritional requirement