Effect of a late evening snack on outpatients with liver cirrhosis.

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Hepatol Res.

2007 May 22; [Epub ahead of print]

Effect of a late evening snack on

outpatients with liver cirrhosis.

Aoyama K, Tsuchiya M, Mori K, Kubo Y, Shiraishi K, Sakaguchi E, Yamashita S, Sakaida I.

Department of Gastroenterology & Hepatology Ube, Japan.

Aims: We have reported that one-week administration of a late evening snack

(LES) improved not only malnutrition but also glucose intolerance in

hospitalized patients with liver cirrhosis. Thus, we

investigated whether long-term LES administration to outpatients for 3 months

could reproduce the results obtained from hospitalized patients, especially

improved glucose intolerance. If this treatment

aggravated glucose intolerance, we tried to find any marker predicting this

aggravation before the treatment. Methods: Outpatients

were prescribed one pack of oral supplementation of a branched-chain amino acid

(BCAA)-enriched nutrient, Aminoleban EN (210 kCal) as a LES without dietician supervision. Both before LES administration and after 3 months, glucose

tolerance and liver function were examined using a 75 g oral glucose tolerance

test (OGTT), biochemical parameters in blood and the relationship between

glucose tolerance (area under the curve (AUC)) and the following serum markers. Results: Branched-chain amino acid/tyrosine ratio (BTR),

the number of red blood cells (RBC), and hematocrit

(Ht) significantly increased, with significant reduction of blood NH(3) level

in patients with a blood glucose level less than 200 mg/dL

2 h after 75 g OGTT. However, the increase of AUC was

seen after 3 months of LES administration in patients who had blood glucose

higher than 200 mg/dL 2 h after 75 g OGTT. AUC weakly correlated positively with serum 7S collagen

and negatively with choline esterase (ChE) and albumin (Alb). Conclusion:

75 g OGTT is a useful marker to predict the worst outcome and avoid the adverse

effect of LES treatment in liver cirrhosis patients if performed without

adequate nutrient conduct by a dietician.

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