Protein-Energy Malnutrition in Patients with Liver Cirrhosis

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Protein-energy malnutrition (PEM) is frequently seen in patients with liver cirrhosis. This condition is associated with a poor prognosis and reduced survival. We investigated the protein and energy metabolic status, including serum albumin concentration, and resting energy expenditure (REE) and respiratory quotient (RQ) measured by indirect calorimetry in 23 patients with liver cirrhosis (8 men and 15 women; mean age, 60.3 years). The median value of %REE (measured REE / predicted REE) was highest in Child-Pugh grade A and lowest in grade C, and the range of RQ tended to be highest in Child-Pugh grade A and lowest in grade C, although there were not statistically significant (p=0.871 and 0.664, respectively). Serum triglyceride concentration was significantly lower in patients who had an RQ less than 0.85 than in patients who had an RQ of 0.85 or more, and free fatty acid tended to be higher in patients who had an RQ less than 0.85 than in patients who had an RQ of 0.85 or more. Of the 23 patients, 78.3% were in a state of protein and/or energy malnutrition and 47.8% had PEM. Our results suggest that %REE and RQ were not significantly associated with liver function, but the oxidation rate of fat was increased in advanced liver cirrhosis. A longitudinal study in a large population is needed to determine the efficacy of %REE and RQ measurements for adequate nutritional treatment and improvement of patient outcome.