ONE-MONTH REGULAR ORAL NUTRITION IN ALCOHOLIC CIRRHOTIC-PATIENTS - CHANGES OF NUTRITIONAL-STATUS, HEPATIC-FUNCTION AND SERUM-LIPID PATTERN

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 inpatients. 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 (P < 0.001) in keeping with an improvement of their nutritional status as evaluated by means of height-creatinine index, muscular mid-arm circumference, tricipital skinfold thickness (P < 0.01 for all) and fat mass (P < 0.001), Assessment of liver function tests showed that levels of aspartate aminotransferase (EC 2.6.1.1), gamma-glutamyl transferase (EC 2.3.2.2) and bilirubin decreased (P < 0.05, P < 0.02 and P < 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 and P < 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 and P < 0.02 respectively). Moreover, changes in cholesterol and HDL-cholesterol correlated with those in transthyretin (P < 0.02 and P < 0.05 respectively). The changes in ApoA1 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.