Inadequate nutritional intake and protein-energy malnutrition involved in acute and chronic viral hepatitis Chinese patients especially in cirrhosis patients.

BACKGROUND/AIMS: Early detection and treatment of protein-energy malnutrition have great clinical significance in patients with liver disease. The aim of study was to evaluate the nutritional status and determine the prevalence of malnutrition in acute and chronic viral hepatitis in Chinese patients, especially in cirrhosis patients. METHODOLOGY: A total of 315 patients were enrolled in this project, 20 patients with acute viral hepatitis, 142 patients with chronic viral hepatitis and 153 patients with posthepatitic liver cirrhosis. Recorded dietary nutrititional intakes and evaluated nutitional status by subjective global assessment, anthropometrics and biochemical data were carried out consecutively. RESULTS: According to the Chinese Dietary Recommended Nutrient Intakes based on sex and age, 73.0% +/- 29.66% of cirrhotic patients, 68.10% +/- 28.65% of chronic hepatitis patients, and 63.38% +/- 29.24% of acute hepatitis patients had deficient energy and nutrients intake. The prevalence of malnutrition was higher in the cirrhotic group as compared with the chronic or acute hepatitis groups according to the subjective global assessment, measured as triceps skinfold thickness in females, mid-upper arm muscle circumference in both male and female patients, albumin, prealbumin, hemoglobin, and serum transferrin (p < 0.05, respectively). CONCLUSIONS: This study demonstrated that Chinese patients with acute and chronic viral hepatitis and liver cirrhosis had inadequate energy and nutritional intake. Protein-energy malnutrition was more severe in cirrhotic patients, indicating a need for early enteral and perenteral treatment.

[Energy metabolism in patients with severe chronic viral hepatitis].

OBJECTIVE: To evaluate the pattern of energy metabolism of patients with chronic viral severe hepatitis. METHODS: Resting energy expenditure (REE) in 55 patients with chronic viral severe was measured with open-circuit indirect calorimetry. Their normal REE was predicted by Harris-Benedict equation (HBE). The patients were to eat the ordinary diet from the department of nutrition of the hospital. The diet was recorded for 3 days. RESULTS: The REE value of the patients with chronic viral severe hepatitis based on cirrhosis was 19.2 +/- 6.1 kcal.kg(-1).d(-1), significantly lower than the normal predicted REE (22.1 +/- 2.2 kcal.kg(-1).d(-1), P < 0.01). The REE value of the patients with chronic viral severe hepatitis based on chronic hepatitis was 20.7 +/- 6.0 kcal.kg(-1).d(-1), significantly lower than the normal predicted REE (23.1 +/- 2.3 kcal.kg(-1).d(-1), P < 0.05). The intake of carbohydrates was 21.6 +/- 7.4 kcal.kg(-1).d(-1), significantly higher than oxidation amount (7.9 +/- 7.3 kcal.kg(-1).d(-1), P < 0.01). While the intake values of fat and protein were 3.4 +/- 1.6 kcal.kg(-1).d(-1) and 4.1 +/- 2.5 kcal.kg(-1).d(-1), both lower than the needed amounts. There was no significant correlation between energy metabolism and liver function. There was a positive correlation between glucose in serum and fat oxidation (r = 0.310, P < 0.05). The serum total protein (TP) level was positively correlated with carbohydrate oxidation (r = 0.362, P < 0.01) and RQ (r = 0.348, P < 0.01); The serum cholesterol level was positively correlated with carbohydrate oxidation (r = 0.338, P < 0.05) and RQ (r = 0.354, P < 0.01). The protein oxidation was negatively correlated with serum TP (r = -0.284, P < 0.05), and serum triglyceride (TG) (r = -0.387, P < 0.05). Fat oxidation was negatively correlated with cholesterol (r = -0.328, P < 0.05). CONCLUSION: Hypometablosim is found in severe chronic hepatitis. There is no significant correlation between energy metabolism and liver function. There is certain correlation between energy metabolism and some parameters in serum, such as glucose, TP, cholesterol, and TG. It may decrease the oxidation of fat and protein to increase the oxidation of carbohydrates.