Indirect Calorimetry and Anthropometry to Estimate Energy Metabolism in Patients with Liver Cirrhosis
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概要
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Energy malnutrition worsens survival in patients with liver cirrhosis, and is currently defined as non-protein respiratory quotient (npRQ) <0.85, as measured by indirect calorimetry. However, measurement of this npRQ is limited because of the high cost of indirect calorimetry. Therefore, we sought an alternative marker that can be used in the routine clinical setting. Forty-four inpatients with cirrhosis were recruited in this study. The last meal was served at 18:00 h on the previous day, and indirect calorimetry was performed between 07:00 and 09:00 h while the patients were still in bed. Fasting blood samples were collected in the early morning on the day of the test. Anthropometry was performed by an expert dietician. The correlations among npRQ, Child-Pugh score of disease severity, laboratory parameters, %AC (arm circumference), %TSF (triceps skinfold thickness), and %AMC (arm muscle circumference) were studied using simple linear regression analysis. ROC (Receviver operating characteristic) analysis was used to identify the cut-off values that would best predict npRQ=0.85. npRQ correlated significantly with %AC (r2=0.204, p=0.0021) and %AMC (r2=0.178, p=0.0043) but not with %TSF. npRQ was not significantly correlated with other laboratory or anthropometric measurements. The cut-off value for %AC that showed the largest AUC (area under the curve) by ROC analysis was 95, while that for %AMC was 92. Multiple regression analysis yielded an equation; npRQ=0.0019×(%AC)20.0134×(Child-Pugh score)+0.7791. Patient stratification by %AC=95 or by regression equation-based npRQ=0.85, but not by %AMC=92, produced significant difference in survival curves. %AC and regression equation could represent npRQ to some extent as parameters of energy nutrition in cirrhosis.
- 2010-12-01
著者
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Saio Masanao
高山赤十字病院 循環器内科
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MORIWAKI H.
Gifu University School of Medicine
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Shimazaki M
Department Of Internal Medicine Gifu University School Of Medicine
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Shimazaki Makoto
岐阜大学 1内
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Moriwaki H
First Department Of Internal Medicine Gifu University Graduate School Of Medicine
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Moriwaki Hisataka
岐阜大学 医学部内科学
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Moriwaki Hisataka
がん･感染症センター都立駒込病院 肝臓内科
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Moriwaki Hisataka
Dep. Of Gastroenterology Gifu Univ. School Of Medicine
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Moriwaki Hisataka
東京大学医科学研究所
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Shiraki Makoto
岐阜大学 医学部内科学
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Suzui Masumi
Internal Medicine Gifu University School Of Medecine
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Suzui Masumi
琉球大学 医学部腫瘍病理学
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Suzui Masumi
琉球大学 医学部病理学
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IWASA Junpei
Department of Medicine, Gifu University Graduate School of Medicine
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TERAKURA Yoichi
Department of Medicine, Gifu University Graduate School of Medicine
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Mohri Hiromi
1st Department Of Internal Medicine Gifu University School Of Medicine
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Moriwaki Hisataka
The First Department Of Internal Medicine Gifu University School Of Medicine
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Shimizu Masahito
Department Of Medicine Gifu University Graduate School Of Medicine
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Nakai Minoru
First Department Of Internal Medicine Gifu University Hospital
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Iwasa Junpei
Department Of Medicine Gifu University Graduate School Of Medicine
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TERAKURA Yoichi
The First Department of Internal Medicine, Gifu University School of Medicine
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SHIRAKI Makoto
The First Department of Internal Medicine, Gifu University School of Medicine
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NISHIMURA Kayoko
Center of Nutrition Support and Infection Control, Gifu University Hospital
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IWASA Junpei
The First Department of Internal Medicine, Gifu University School of Medicine
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NAGAKI Masahito
The First Department of Internal Medicine, Gifu University School of Medicine
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Moriwaki H
Gifu Univ. School Of Medicine Gifu Jpn
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Moriwaki H.
First Department Of Internal Medicine Gifu University School Of Medicine
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Nagaki Masahito
Department Of Gastroenterology Gifu University Hospital
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Saio Masanao
Department Of Medicine Gifu University Graduate School Of Medicine
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Terakura Yoichi
The First Department Of Internal Medicine Gifu University School Of Medicine
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Shimizu Masahito
First Department Of Internal Medicine Gifu University Graduate School Of Medicine
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Moriwaki H.
Department Of Internal Medicine Gifu University
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Nishimura Kayoko
Center Of Nutrition Support And Infection Control Gifu University Hospital
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Shiraki Makoto
First Department Of Internal Medicine Gifu University School Of Medicine
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Shimizu Masaru
Department Of Medicine Gifu University Graduate School Of Medicine
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Moriwaki Hisataka
Department Of Medicine Gifu University Graduate School Of Medicine
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