One-month regular oral nutrition in alcoholic cirrhotic patients. Changes of nutritional status, hepatic function and serum lipid pattern

Abstract

The effect of a regular oral diet supplying 167 kJ/kg per d (40 kcal/kg per d) on nutritional state, liver function and serum lipid profile was assessed in thirty severely malnourished alcoholic cirrhotic in-patients. Their diet was monitored by a trained dietitian and they were vigorously encouraged to eat all meals served. One month after their entry into the study, protein and energy intakes were significantly higher (P0·001) in keeping with an improvement of their nutritional status as evaluated by means of height-creatinine index, muscular mid-arm circumference, tricipital skinfold thickness (P0·01 for all) and fat mass (P0·001). Assessment of liver function tests showed that levels of aspartate amino-transferase (EC2.6.1.1), y-glutamyl transferase (EC2.3.2.2) and bilirubin decreased (P <0·05,P> 0·02 andP> 0·05 respectively) while prothrombin time values increased (P< 0·05). Similarly, serum albumin increased modestly while transthyretin did not change. Orosomucoid and C-reactive protein decreased (P< 0·001 andP< 0·01 respectively), indicating an improvement of the inflammatory state. Apolipoprotein Al and high-density-lipoprotein (HDL)-cholesterol correlated with several tests of liver function and improved significantly during the study period (P< 0·001 andP< 0·02 respectively). Moreover, changes in cholesterol and HDL-cholesterol correlated with those in transthyretin (P< 0·02 andP< 0·05 respectively). The changes in ApoAl and HDL-cholesterol were greater in patients whose fat mass increased significantly. Our findings show that adequate oral nutrition resulted in a better nutritional status in cirrhotics after 1 month of hospitalization. The serum lipid variables appeared to be more useful indicators of functional liver improvement than the classic liver function tests which rather indicate liver damage.