Hostname: page-component-cd9895bd7-hc48f Total loading time: 0 Render date: 2024-12-24T12:55:53.052Z Has data issue: false hasContentIssue false
  • English
  • Français

Nutritional assessment and adequacy of dietary intake in hospitalized patients with alcoholic liver cirrhosis

Published online by Cambridge University Press:  09 March 2007

Klaus Nielsen ,
Jens Kondrup ,
Lars Martinsen ,
Birgitte Stilling  and
Berit Wikman
Klaus Nielsen
Affiliation:
Medical Department A, Rigshospitalet, Blegdamsvej 9, DK-2100 ø, Copenhagen, Denmark
Jens Kondrup
Affiliation:
Medical Department A, Rigshospitalet, Blegdamsvej 9, DK-2100 ø, Copenhagen, Denmark
Lars Martinsen
Affiliation:
Medical Department A, Rigshospitalet, Blegdamsvej 9, DK-2100 ø, Copenhagen, Denmark
Birgitte Stilling
Affiliation:
Medical Department A, Rigshospitalet, Blegdamsvej 9, DK-2100 ø, Copenhagen, Denmark
Berit Wikman
Affiliation:
Medical Department A, Rigshospitalet, Blegdamsvej 9, DK-2100 ø, Copenhagen, Denmark
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

Nutritional assessment and adequacy of spontaneous dietary intake was evaluated in thirty-seven clinically stable hospitalized patients with alcoholic liver cirrhosis. About two-thirds of the patients had ascites or oedema, or both, and, therefore, body weight could not be used for assessment of nutritional status. Lean body mass (LBM; measured by three consecutive 24 h creatinine excretions) was 62 (range 40–95)% of reference values, mid-arm-muscle area (MAMA) was 70 (range 43–115)% and triceps skinfold (TSF) was 45 (range 20–113)% of reference values (all median values). In patients without ascites or oedema, or both, there was a rectilinear correlation between body weight and LBM and between body weight and MAMA (r 0.93 and 0.85 respectively). In patients with ascites or oedema, or both, the correlation between body weight and LBM was poor as could be expected. We suggest that LBM is a useful measure of nutritional status when body weight is unreliable because of ascites or oedema, or both. Energy balance for the group was calculated from energy intake recorded by a 24 h dietary recall and energy expenditure calculated by the factorial method. Median intake was 102 (range 34–176)% of expenditure. N loss was calculated from the average of three 24 h urea excretions. Protein intake was calculated from the 24 h dietary recall. The N balance was positive in the patients as a group (median intake was 120 (range 26–183)% of output). The most malnourished patients tended to have the most positive N balance which was due to a significantly lower N excretion. The protein requirement for N balance was 0.83 (SE 0.05) g/kg per d and only at an intake above 1.20 g/kg per d were all patients in positive N balance. The median intakes of thiamin, folacin, vitamin D, vitamin E, Mg, and Zn were judged to be insufficient. It is concluded that impaired nutritional status is common among patients with liver cirrhosis, even in a stable clinical condition. It is suggested that nutritional status in these patients is evaluated by dietary recalls, in combination with measurement of body weight in patients without ascites or oedema, or both, or in combination with determination of LBM by three 24 h creatinine excretions in patients with ascites or oedema, or both. Criteria for selection of patients that might benefit from nutritional therapy are discussed.

Keywords

Nutritional statusDietary intakeAlcoholic liver cirrhosisHospital patients
Type
Estimation of Human Body Composition
Information
British Journal of Nutrition , Volume 69 , Issue 3 , May 1993 , pp. 665 - 679
Copyright
Copyright © The Nutrition Society 1993

References

Acheson, K. J., Campbell, I. T., Edholm, O. G., Miller, D. S. & Stock, M. J. (1980 a). The measurement of food and energy in man – an evaluation of some techniques. American Journal of Clinical Nutrition 33, 1147–1154.CrossRefGoogle Scholar
Acheson, K. J., Campbell, I. T., Edholm, O. G., Miller, D. S. & Stock, M. J. (1980 b). The measurement of daily energy expenditure an evaluation of some techniques. American Journal of Clinical Nutrition 33, 1155–1164.CrossRefGoogle ScholarPubMed
Appleyard, M. (1987). The Copenhagen City Heart Study. Scandinavian Journal of Social Medicine 41, Suppl., 88–92.Google Scholar
Barac-Nieto, M., Spurr, G. B., Lotero, H. & Maksud, M. G. (1978). Body composition in chronic undernutrition. American Journal of Clinical Nutrition 31, 23–40CrossRefGoogle ScholarPubMed
Barac-Nieto, M., Spurr, G. B., Lotero, H., Maksud, M. G. & Dahners, H. W. (1979). Body composition during nutritional repletion of severely undernourished men. American Journal of Clinical Nutrition 32, 981–991.CrossRefGoogle ScholarPubMed
Bistrian, R. B. (1977). Nutritional assessment and therapy of protein-calorie malnutrition in the hospital. Journal of the American Dietetic Association 71, 393–397.CrossRefGoogle ScholarPubMed
Bunout, D., Aicardi, V., Hirseh, S., Petermann, M., Kelly, M., Silva, G., Garay, P., Ugarte, G. & Iturriaga, H. (1989). Nutritional support in hospitalized patients with alcoholic liver disease. European Journal of Clinical Nutrition 43, 615–621.Google ScholarPubMed
Cabre, E., Gonzalez-Huix, F., Abad-Lacruz, A., Esteve, M., Acero, D., Fernandez-Banares, F., Xiol, X. & Gassull, M. A. (1990). Effect of total enteral nutrition on the short-term outcome of severely malnourished cirrhotics. Gastroenterology 98, 715–72O.CrossRefGoogle ScholarPubMed
Delwaide, P. A. (1972). Body potassium measurements by whole-body counting:screening of patient populations. Journal of Nuclear Medicine 14, 40–48.Google Scholar
Diehl, A. M., Boitnott, J. K., Herlong, H. F., Potter, J. J., Van Duyn, M. A., Chandler, E. & Mezey, E. (1985). Effect of parenteral amino acid supplementation in alcoholic hepatitis. Hepatology 5, 57–63.CrossRefGoogle ScholarPubMed
Dolz, C., Raurich, J. M., Ibanez, J., Obrador, A., Marse, P. & Gaya, J. (1991). Ascites increase the resting energy expenditure in liver cirrhosis. Gastroenterology 100, 738–744.CrossRefGoogle ScholarPubMed
Dossing, M., Poulsen, H. E., Andreasen, P. B. & Tygstrup, N. (1982). A simple method for determination of antipyrine clearance. Clinical Pharmacology and Therapeutics 32, 392–396.CrossRefGoogle ScholarPubMed
Durnin, J. V. G. A. & Passmore, R. (1967). Energy, Work and Leisure. London: Heinemann.Google Scholar
Edwards, D. A., Hammond, W. H., Healy, M. J., Tanner, J. M. & Whitehouse, R. H. (1955). Design and accuracy of calipers for measuring subcutaneous tissue thickness. British Journal of Nutrition 9, 133–143.CrossRefGoogle ScholarPubMed
Forbes, G. B. & Bruining, G. J. (1976). Urinary creatinine excretion and lean body mass. American Journal of Clinical Nutrition 29, 1359–1366.CrossRefGoogle ScholarPubMed
Frisancho, A. R. (1981). New norms of upper limb fat and muscle areas for assessment of nutritional status. American Journal of Clinical Nutrition 34, 2540–2545.CrossRefGoogle ScholarPubMed
Garrison, R. N., Cryer, H. M., Howard, D. A. & Polk, H. C. (1984). Clarification of risk factors for abdominal operations in patients with hepatic cirrhosis. Annals of Surgery 199, 648–655.CrossRefGoogle ScholarPubMed
Hajnal, F., Flores, M. C., Radley, S. & Valenzuela, J. E. (1990). Effect of alcohol and alcoholic beverages on mealstimulated pancreatic secretion in humans. Gastroenterology 98, 191–196.CrossRefGoogle ScholarPubMed
Haraldsdottir, J., Holm, L., Jensen, H. J. & Møller, A. (1987 a). Dietary Habits in Denmark 1985. Copenhagen: National Food Agency.Google Scholar
Haraldsdottir, J., Holm, L., Jensen, H. J. & Møller, A. (1987 b). Dietary Habits in Denmark 1985. Who Eats What? Copenhagen: National Food Agency.Google Scholar
Harris, J. A. & Benedict, F. G. (1919). A Biometric Study of Basal Metabolism in Man. Carnegie Institute of Washington Publication no. 279, p. 227. Washington, DC: Carnegie Institute.Google Scholar
Harvey, K. B., Moldawer, L. L., Bistrian, B. R. & Blackburn, G. L. (1981). Biological measures for the formulation of a hospital prognostic index. American Journal of Clinical Nutrition 34, 2013–2022.CrossRefGoogle ScholarPubMed
Heitmann, B. L. (1991). Body fat in the adult Danish population aged 35–65 years: an epidemiological study. International Journal of Obesity 15, 535–545.Google ScholarPubMed
Heymsfield, S. B., McManus, C., Smith, J., Stevens, V. & Nixon, D. W. (1982). Anthropometric measurement of muscle mass: revised equations for calculating bone-free arm muscle area. American Journal of Clinical Nutrition 36, 680–69O.CrossRefGoogle ScholarPubMed
Heymsfield, S. B., Arteaga, C., McManus, C., Smith, J. & Moffitt, S. (1983). Measurement of muscle mass in humans: validity of 24-hour urinary creatinine method. American Journal qf Clinical Nufrition 37, 478–494.CrossRefGoogle ScholarPubMed
Isaksson, B. (1973). Clinical nutrition. Requirement of energy and nutrients in disease. Bibliotheca Nutritio et Dieta 19, 1–10,Google Scholar
Kondrup, J., Nielsen, K. & Hamberg, O. (1992). Nutritional therapy in patients with liver cirrhosis. European Journal of Clinical Nutrition 46, 239–246.Google ScholarPubMed
Lindberg, W., Natvig, H., Rygh, A. & Svendsen, K. (1956). Height and weight in adult men and women. Tidskr Nor Laegeforen 76, 361–368.Google Scholar
McCullough, A. J.Mullen, K. D. & Kalhan, S. C. (1991). Measurements of total bodv and extracellular water in cirrhotic patients with and without ascites. Hepatology 14, 1102–1111.CrossRefGoogle Scholar
Martinsen, L., Kondrup, J., Larsson, B., Hansen, J. K., Døsssing, H. & Nielsen, K. (1990 a). Oxygen uptake and substrate flux during exercise in patients with liver cirrhosis. Clinical Nutrition 9, Suppl., 47.CrossRefGoogle Scholar
Martinsen, L., Kondrup, J., Stilling, B., Døssing, H. & Nielsen, K. (1990 b). Energy expenditure measured with the doubly labelled water method in patients with alcoholic liver cirrhosis and ascites. Clinical Nutrition 9, Suppl., 37.CrossRefGoogle Scholar
Mendenhall, C. L., Anderson, S., Weesner, R. E., Goldberg, S. J. & Crolic, K. A. (1984). Protein-calorie malnutrition associated with alcoholic hepatitis. American Journal of Medicine 76, 211–222.CrossRefGoogle ScholarPubMed
Merli, M.. Romiti, A., Riggio, O. & Capocaccia, L. (1987). Optimal nutritional indexes in chronic liver disease. Journal of Purenteral and Enteral Nutrition 11, 130–134.Google ScholarPubMed
Mezey, E., Caballeria, J., Mitchell, M. C., Pares, A., Herlong, H. F. & Rodes, J. (1991). Effects of parenteral amino acid supplementation on short-term and long-term outcomes in severe alcoholic hepatitis: a randomized controlled trial. Hepatology 14, 1090–1096.CrossRefGoogle ScholarPubMed
Mezey, E., Kolman, C. J., Diehl, A. M., Mitchell, M. C. & Herlong, H. F. (1988). Alcohol and dietary intake in the development of chronic pancreatitis and liver disease in alcoholism. American Journal qf Clinical Nutrition 48, 148–151.CrossRefGoogle ScholarPubMed
Møller, A. (1983). Foodtables. Copenhagen: National Food Agency.Google Scholar
Müller, M. J., Fenk, A., Lautz, H., Selberg, O., Canzler, H., Balks, H. J., Von Zur Mühlen, A., Schmidt, E. & Schmidt, F. W. (1991). Energy expenditure and substrate metabolism in ethanol-induced liver cirrhosis. American Journal of Physiology 260, E338–E344.Google ScholarPubMed
National Research Council (1989). Recommended Dietary Allowances, 10th revised ed. Washington, DC: National Academy Press.Google Scholar
Naveau, S., Pelletier, G., Poynard, T., Attali, P., Poitrine, A., Buffet, C., Etienne, J.-P. & Chaput, J.-C. (1986). A randomized clinical trial of supplementary parenteral nutrition in jaundiced alcoholic cirrhotic patients. Hepatology, 6, 270–274.CrossRefGoogle ScholarPubMed
O'Keefe, S. J., El-Zayadi, A. R., Carraher, T. E., Davis, M. & Williams, M. (1980). Malnutrition and immuno-incompetence in patients with liver disease. Lancet ii, 615–617.CrossRefGoogle Scholar
Owen, O. E., Trapp, V. E., Reichard, G. A., Mozzoli, M. A. Jr, Moctezuma, J., Paul, P., Skutches, C. L. & Boden, G. (1983). Nature and quantity of fuels consumed in patients with alcoholic cirrhosis. Journal of Clinical Investigation 72, 1821–1832.CrossRefGoogle ScholarPubMed
Russell, D. McR., Prendergast, P. J., Darby, P. L., Garfinkel, P. E., Whitwell, J. & Jeejeebhoy, K. N. (1983). A comparison between muscle function and body composition in anorexia nervosa: the effect of refeeding. American Journal of Clinical Nurrition 38, 229–237.CrossRefGoogle ScholarPubMed
Schneeweiss, B., Graninger, W.. Ferenci, P., Eichinger, S., Grimm, G., Schneider, B., Laggner, A. N., Lenz, K. & Kleinberger, G. (1990). Energy metabolism in patients with acute and chronic liver disease. Hepatology 11, 387–393.CrossRefGoogle ScholarPubMed
Shanbhogue, R. L. K., Bistrian, B. R., Jenkins, R. L., Jones, C., Benotti, P. & Blackburn, G. L. (1987). Resting energy expenditure in patients with end-stage liver disease and in normal population. Journal of Parenteral and Enteral Nutrition 11, 305–308.CrossRefGoogle ScholarPubMed
Shaw, B. W., Wood, R. P., Gordon, R. D., Shunzaburo, I., Gillquist, W. P. & Starzl, T. E. (1985). Influence of selected patient variables and operative blood loss on six-month survival following liver transplantation. Seminar on Liver Diseases 5, 385–393.CrossRefGoogle ScholarPubMed
Sherlock, S. (1984). Nutrition and the alcoholic. Lancet i, 436–439.CrossRefGoogle Scholar
Shizgal, H. M. (1983). Body composition. In Surgical Nutrition, pp. 3–17 [Fishers, P., editor] Boston: Little, Brown & Co.Google Scholar
Simon, D. S. & Galambos, J. T. (1987). Peripheral hyperalimentation (PPN) in alcoholic hepatitis (AH). Gastroenterology 92, 1777.Google Scholar
Souba, W. W. & Wilmore, D. W. (1988). Diet and nutrition in the care of the patient with surgery, trauma and sepsis. In Modern Nutrition in Health and Diseuse, 7th ed., p. 1326 [Shils, M. E. and Young, V. R., editors]. Philadelphia: Lea & Febiger.Google Scholar
Swart, G. R., van den Berg, J. W. O., Van Vurre, J. K., Rietveld, T., Wattimena, D. L. & Frenkel, M. (1989). Minimum protein requirement in liver cirrhosis determined by nitrogen balance measurements at three levels of protein intake. Clinical Nutrition 8, 329–336.CrossRefGoogle ScholarPubMed
Tygstrup, N. (1966). Determination of the hepatic elimination capacity (Lm) of galactose by single injection. Scandinavian Journal of Clinical and Laboratory Investigation 18, 118–125.Google ScholarPubMed
Walser, M. (1987). Creatinine excretion as a measure of protein nutrition in adults of varying age. Journal of Parenteral and Enteral Nutrition 11, 73s–78s.CrossRefGoogle ScholarPubMed