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Effect of long-term refeeding on protein metabolism in patients with cirrhosis of the liver

Published online by Cambridge University Press:  09 March 2007

Jens Kondrup ,
Klaus Nielsen  and
Anders Juul
Jens Kondrup
Affiliation:
The Clinical Nutrition Unit and Division of Hepatology, Department of Medicine A & Department of Growth and Reproduction, Rigshospitalet, 9 Blegdamsvej, DK-2100 Ø, Copenhagen, Denmark
Klaus Nielsen
Affiliation:
The Clinical Nutrition Unit and Division of Hepatology, Department of Medicine A & Department of Growth and Reproduction, Rigshospitalet, 9 Blegdamsvej, DK-2100 Ø, Copenhagen, Denmark
Anders Juul
Affiliation:
The Clinical Nutrition Unit and Division of Hepatology, Department of Medicine A & Department of Growth and Reproduction, Rigshospitalet, 9 Blegdamsvej, DK-2100 Ø, Copenhagen, Denmark
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Abstract

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Patients with cirrhosis of the liver require an increased amount of protein to achieve N balance. However, the utilization of protein with increased protein intake, i.e. the slope from regression analysis of N balance v. intake, is highly efficient (Nielsen et al. 1995). In the present study, protein requirement and protein utilization were investigated further by measuring protein synthesis and degradation. In two separate studies, five or six patients with cirrhosis of the liver were refed on a balanced diet for an average of 2 or 4 weeks. Protein and energy intakes were doubled in both studies. Initial and final whole-body protein metabolism was measured in the fed state by primed continous [15N]glycine infusion. Refeeding caused a statistically significant increase of about 30% in protein synthesis in both studies while protein degradation was only slightly affected. The increase in protein synthesis was associated with significant increases in plasma concentrations of total amino acids (25%), leucine (58%), isoleucine (82%), valine (72%), proline (48%) and triiodothyronine (27%) while insulin, growth hormone, insulin-like growth factor (IGF)-I and IGF-binding protein-3 were not changed significantly. The results indicate that the efficient protein utilization is due to increased protein synthesis, rather than decreased protein degradation, and suggest that increases in plasma amino acids may be responsible for the increased protein synthesis. A comparison of the patients who had a normal protein requirement with the patients who had an increased protein requirement suggests that the increased protein requirement is due to a primary increase in protein degradation. It is speculated that this is due to low levels of IGF-I secondary to impaired liver function, since initial plasma concentration of IGF-I was about 25% of control values and remained low during refeeding.

Keywords

Nitrogen retentionProtein metabolismAlcoholic cirrhosis
Type
Human and Clinical Nutrition
Information
British Journal of Nutrition , Volume 77 , Issue 2 , February 1997 , pp. 197 - 212
Copyright
Copyright © The Nutrition Society 1997

References

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