Author:
Tajika MD, et al in Journal of Nutrition (March 2002)
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Date Posted: Fri, March 08 2002, 11:20:59 PST
In reply to:
Jorquera F, et al Am J Gastroenterol 2001 Aug;96(8):2456-61
's message, "Impairment of metabolic function in chronic hepatitis C" on Fri, August 24 2001, 15:52:34 PDT
Nutrition
Volume 18, Issue 3
March 2002
Pages 229-234
DOI: 10.1016/S0899-9007(01)00754-7
PII: S0899-9007(01)00754-7
Copyright © 2002 Elsevier Science Inc. All rights reserved.
Applied nutritional investigation
Prognostic value of energy metabolism in patients with viral liver cirrhosis*1
Masahiro Tajika MDa, Masahiko Kato MDa, Hiromi Mohri MDa, Yoshiyuki Miwa
MDa, Tomohiro Kato MDa, Hiroo Ohnishi MDa, b and Hisataka Moriwaki MDa, ,
a First Department of Internal Medicine, Gifu University School of
Medicine, Gifu, Japan
b Department of Gastroenterology, Gifu Prefectural Gifu Hospital, Gifu, Japan
Available online 5 March 2002.
Abstract
The effect of energy malnutrition on survival in patients with
non-alcoholic viral liver cirrhosis has not been well defined. We
characterized energy metabolism at study entrance and prospectively
analyzed its effect on subsequent survival in cirrhotics. One hundred nine
consecutive patients with viral liver cirrhosis and 22 healthy control
subjects participated in the study. By indirect calorimetry after overnight
bedrest and fasting, resting energy expenditure (REE) was measured and
non-protein respiratory quotient (npRQ) was calculated. Survival of
cirrhotics were followed for up to 8 y. Survival rate was estimated with
the Kaplan-Meier method. REE at entrance was significantly higher than the
predicted basal metabolic rate (BMR) in cirrhotics (P < 0.001). NpRQ was
significantly lower in cirrhotics than in controls (P < 0.001). Survival
rate was significantly lower in patients with low npRQ ( < 0.85) than in
patients with scores above 0.85 (P < 0.01) and was significantly higher in
normal metabolic patients (0.9 < REE/BMR < 1.1) than in hypometabolic
(REE/BMR < 0.9) or hypermetabolic (1.1 < REE/BMR) patients (P < 0.05). The
proportional hazards model showed that npRQ (relative RISK = 0.0003, 95%
confidence INTERVAL = 0.0000¯0.0970), REE/BMR (0.0199, 0.0007¯0.5652),
prothrombin time, and ammonia were independent significant factors
determining survival. Thus evaluation of energy metabolism can be used to
predict survival in patients with viral liver cirrhosis.
Author Keywords: viral liver cirrhosis; energy metabolism; indirect
calorimetry; resting energy expenditure; non-protein respiratory quotient;
survival
*1 This work was supported in part by grants-in-aid from the Ministry of
Health and Welfare of Japan and the Danon Health and Nutrition Promotion
Society.
Correspondence to: Hisataka Moriwaki, MD, PhD, Professor, First Department
of Internal Medicine, Gifu University School of Medicine, 40 Tsukasa-machi,
Gifu 500-8705, Japan; email: hmori@lcc.gifu-u.ac.jp
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