Effects of Nutritional Supplementation on Nutirtional Status in Patients with Nonalcoholic Liver Cirrhosis

비알콜성 간경변증 환자에서 영양보충에 따른 영양개선의 효과

  • 안수현 (연세대학교 생활과학대학 식품영양학과) ;
  • 김오연 (연세대학교 노화과학연구소) ;
  • 이종호 (연세대학교 생활과학대학 식품영양학과, 노화과학연구소) ;
  • 김지영 (연세대학교 생활과학대학 식품영양학과) ;
  • 한광협 (연세대학교 의과대학 소화기내과)
  • Published : 2003.07.01

Abstract

Severe protein-calorie malnutrition, common in patients with advanced liver disease, can seriously undermine the capacity for regeneration and functional restoration of liver. Nutritional supplementation for these patients can improve biochemical and hormonal abnormalities. However, these effects were not identified in patient with nonalcoholic liver cirrhosis. To determine effects of nutritional supplementation in patients with nonalcoholic liver cirrhosis, 77 subjects aged 29 to 69 years participated in this study for 12 weeks and were subdivided into three groups; normal diet group (Control group, n = 16), branched-chain amino acid supplementation group (BCAA group, n = 31), nutritional supplementation group (NS group, n = 30). Anthropometric parameters, hemoglobin, hematocrit, blood cell counts, serum levels of lipids, vitamins, minerals and fatty acid composition, and plasma amino acids were examined. The mean values of age and height, and the initial values of weight and body mass index (BMI) were not different among all groups. After 12 weeks, there were no significant changes in these values in Control group. Only NS group showed significant increases in weight, lean body mass, midarm circumference, triceps skinfold thickness. Serum transferrins were increased both in BCAA and NS groups. Plasma levels of branched-chain amino acids, urea amino acids and glutamic acid were also significantly increased in these groups, but plasma levels of ammonia, serum LDL cholesterol and atherogenic index were decreased. However, there were no significant changes in serum levels of vitamin and mineral and composition of fatty acids in phospholipids in these groups. These results showed that the nutritional supplementation for patients with nonalcoholic liver cirrhosis can more improve nutritional status in these people together with increases of weight, body fat and lean body mass, compared to only BCAA supplementation. To ascertain and investigate the appropriate nutritional supplementation for patients with nonalcoholic liver cirrhosis, further studies are necessary.

Keywords

References

  1. Statistical Result on Mortality Korea national statistical office
  2. WHO. 1996 World health statistics, 1998
  3. Moon HY, Moon YM, Han KH, Jeon JY, Kang JK Park IS. Clinical case study for patients with primary liver carcinoma according to the types of infection. J Inter Med 47S: 33, 1995
  4. Mendelhall CL, Moritz TE, Roselle GA, Morgan TR, et al. A study of oral nutritional support with oxandralone in malnourished patients with alcoholic hepatitis: results of a department of veterans affairs cooperative study. Hepatology 17: 564-568, 1993 https://doi.org/10.1002/hep.1840170407
  5. Dominic J. Nompleggi, Herbert L. Bonkovsky. Nutritional supplementation in chronic liver disease: an analytical review. Hepatology 19(2): 518-533, 1994
  6. Li SD, Leu W, Mobarhan S, Nadir A, Thiel DH, Hagerty A. Nutrition support for individual with liver failure. Nutr Rev 58: 242-247, 2000 https://doi.org/10.1111/j.1753-4887.2000.tb01873.x
  7. Nompleggi DJ, Bonkovsky HL. Nutritional supplementation in chronic liver disease: an analytical review. Hepatology 19: 518-533, 1994 https://doi.org/10.1002/hep.1840190234
  8. Skeie B, Kventan V, Gil KM, Rothkopf MM, Newsholme EA, Askanazi J. Branched amino acid: their metabolism and clinical utility. Care Med 18: 549-571, 1990 https://doi.org/10.1097/00003246-199005000-00019
  9. Christie MN, Sack DM, Pomposelli J, Hort D, Enriched branched chain amino acid formula versus a casein-based supplement in the treatment of cirrohsis. JPEN 9: 671-678, 1985 https://doi.org/10.1177/0148607185009006671
  10. Marchesini G, Bianchi G, Rossi B, Brizi M, Melchionda N. Nutritional treatment with branched-chain amino acids in advanced liver cirrhosis. J Gastroenterol 35: 7-12, 2000
  11. Iber FL, Kinney JM, et al. Alcohol-associated disease. Nutr Metab in Patient Care, pp.439-444, 1988
  12. Di Lima SN. Gastrointestinal disease. Dietitian's patient education manual 1 (7): 14-51, 1992
  13. O'Keefe SJ, EL-Zayadi AR, Carraher TE, et al. Malnutrition and immunocompetence in patients with liver disease. Lancet 2: 615-617, 1980 https://doi.org/10.1016/S0140-6736(80)90284-6
  14. Roongpisuthipong C, Sobhonslidsuk A, Nantriruj K, Songchit-somboon S. Nutritional assessment in various stages of liver cirrhosis. Nutrition 17: 761-765, 2001 https://doi.org/10.1016/S0899-9007(01)00626-8
  15. Caregaro L, Aleverino F, Amodio P, Merkel C, Bolognesi M, Angeli P, Gatta A. Malnutrition in alcoholic and virus-related cirrhosis. Am J Clin Nutr 63: 602-604, 1996
  16. Italian Multicentre Cooperative Project. Nutritional status in cirrhosis: Italian Multicentre Cooperative Project in liver cirrhosis. J Hepatol21: 317-325, 1994 https://doi.org/10.1016/S0168-8278(05)80308-3
  17. Lee S, Jin Y, Kee C, Chang Y. Nutritional status in alcohol- and virus-related liver cirrhosis. Kor J Hetatol 6: 69-72, 2000
  18. Yeum K-J, Lee-Kim YC, Yoon S, Lee KY, Park IS, Lee KS, Kim BS, Tang G, Russell RM, Krinsky NI. Similar metabolites formed from 棺-carotene by human gastric mucosal homogenates, lipoxygenase or linoleic acid hydroperoxide. Arch Biochem Biophys 321: 167-174, 1995 https://doi.org/10.1006/abbi.1995.1382
  19. Anderson A, Battstroem L, Isaksson A, Israelsson B, Hultberg B. Determination of homocystein in plasma by ion-exchange chromatography. Scand J Clin Lab Invest 49: 445-449, 1989 https://doi.org/10.3109/00365518909089120
  20. Ueland PM, Refsum H, Stabler SP, Mailnow MR, Anderson A, Allen RH. Total homocysteine in plasma or serum: method and clinical applications. Clin Chem 39: 1764-1779, 1993
  21. Folch J, Lees M, Stanley GHS. A simple method for the isolation and purification of total lipids from animal tissues. J Biol Chem 226: 497-509, 1957
  22. Lepage G, Roy GC. Direct trans-esterification of all classes of lipids in a one step reaction. J Lipid Res 227: 114-129, 1986
  23. Scott PE, Michael LM, Barrett ER, Kurt GK, Carmen SA, Joseph AW, Sharon WA. Sampling and analysis techniques for monitoring serum for trace elements. Clin Chem 32(7): 350-1356, 1986
  24. Kim YS, Lee HK. Metabolism and nutrition (Frayn KN origin). pp.121-150, Han Medical publishing. Seoul, 1999
  25. Santiago JM. Nutritional Therapies in Liver Disease. Semin Liver Dis 11 (4): 278-291, 1991 https://doi.org/10.1055/s-2008-1040446
  26. Zeman FJ. Liver disease and alcoholism: In 2nd ed. Clinical nutrition and dietetics, pp.571-553, Macmillan Publishing Com. New York NY, 1991
  27. Packard CJ, Shepherd J. Lipoprotein heterogeneity and apolipoprotein B metabolism. Arterioscler Thromb Vasc Biol 17(12) : 3542-56, 1997 https://doi.org/10.1161/01.ATV.17.12.3542
  28. Jansen H, Verhoeven AJM, Sijbrands EJG. Hepatic lipase: a proor anti-atherogenic protein? J Lipid Res 43: 1352-1362, 2002 https://doi.org/10.1194/jlr.R200008-JLR200
  29. Goodman DS. Vitamin A and retinoids in health and disease. N Engl J Med 310: 1023-1031, 1984 https://doi.org/10.1056/NEJM198404193101605
  30. Wu J, Karlsson K, Danielsson A. Effects of vitamins E, C and catalase on bromobenzene- and hydrogen peroxide-induced intracellular oxidation and DNA single-strand breakage in Hep G2 cells. J Hepatol26: 669-77, 1997 https://doi.org/10.1016/S0168-8278(97)80434-5
  31. Blonde-Cynober F, Aussel C, Cynober L. Abnormalities in branched-chain amino acid metabolism in cirrhosis: influence of hormonal and nutritional factors and directions for future research Clin Nutr 18(1): 5-13, 1999 https://doi.org/10.1016/S0261-5614(99)80043-0
  32. Leweling H, Breitkreutz R, Behne F, Staedt U, Striebel JP, Holm E. Hyperammonemia- induced depletion of glutamate and branched-chain amino acids in muscle and plasma. J Hepatol 25: 756-762, 1996 https://doi.org/10.1016/S0168-8278(96)80249-2
  33. Plauth M, Egberts EH, Hamster W ET AL. Long term treatment of latent portosystemic encephalopathy with branched chain amino acids. a double blind placebo controlled corssover study. J Hepatol 17: 308-3154, 1993 https://doi.org/10.1016/S0168-8278(05)80210-7
  34. Cabre E, Gassull M. Polyunsaturated fatty acid deficiency liver disease: pathophysiological and clinical significance. Nutrition 12: 542-548, 1996 https://doi.org/10.1016/S0899-9007(96)00122-0
  35. Smith J, Horowitz J, Henderson JM, Heymsfield S. Enteral hyperalimentation in undernourished patients with cirrhosis and ascites. Am J Clin Nutr 35: 56-72, 1982