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Liver Failure/Cirrhosis/Portal Hypertension
Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: A randomized 12-month trial†
Article first published online: 15 APR 2008
Copyright © 2008 American Association for the Study of Liver Diseases
Volume 48, Issue 2, pages 557–566, August 2008
How to Cite
Plank, L. D., Gane, E. J., Peng, S., Muthu, C., Mathur, S., Gillanders, L., McIlroy, K., Donaghy, A. J. and McCall, J. L. (2008), Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: A randomized 12-month trial. Hepatology, 48: 557–566. doi: 10.1002/hep.22367
Potential conflict of interest: Dr. Gane advises and is on the speakers' bureau of Novartis. He is also on the speakers' bureau of GlaxoSmithKline.
- Issue published online: 29 JUL 2008
- Article first published online: 15 APR 2008
- Accepted manuscript online: 15 APR 2008 12:00AM EST
- Manuscript Accepted: 3 APR 2008
- Manuscript Received: 26 SEP 2007
- Health Research Council of New Zealand
Patients with liver cirrhosis exhibit early onset of gluconeogenesis after short-term fasting. This accelerated metabolic reaction to starvation may underlie their increased protein requirements and muscle depletion. A randomized controlled trial was conducted to test the hypothesis that provision of a late-evening nutritional supplement over a 12-month period would improve body protein stores in patients with cirrhosis. A total of 103 patients (68 male, 35 female; median age 51, range 28–74; Child-Pugh grading: 52A, 31B, 20C) were randomized to receive either daytime (between 0900 and 1900 hours) or nighttime (between 2100 and 0700 hours) supplementary nutrition (710 kcal/day). Primary etiology of liver disease was chronic viral hepatitis (67), alcohol (15), cholestatic (6), and other (15). Total body protein (TBP) was measured by neutron activation analysis at baseline, 3, 6, and 12 months. Total daily energy and protein intakes were assessed at baseline and at 3 months by comprehensive dietary recall. As a percentage of values predicted when well, TBP at baseline was similar for the daytime (85 ± 2[standard error of the mean]%) and nighttime (84 ± 2%) groups. For the nighttime group, significant increases in TBP were measured at 3 (0.38 ± 0.10 kg, P = 0.0004), 6 (0.48 ± 0.13 kg, P = 0.0007), and 12 months (0.53 ± 0.17 kg, P = 0.003) compared to baseline. For the daytime group, no significant changes in TBP were seen. Daily energy and protein intakes at 3 months were higher than at baseline in both groups (P < 0.0001), and these changes did not differ between the groups. Conclusion: Provision of a nighttime feed to patients with cirrhosis results in body protein accretion equivalent to about 2 kg of lean tissue sustained over 12 months. This improved nutritional status may have important implications for the clinical course of these patients. (HEPATOLOGY 2008.)