Weight gain after transjugular intrahepatic portosystemic shunt is associated with improvement in body composition in malnourished patients with cirrhosis and hypermetabolism
Introduction
Protein energy malnutrition is a frequent consequence of hepatic cirrhosis which puts patients at a higher risk of complications [1], death [2], [3], [4], and a complicated course after liver transplantation including death [5], [6]. After successful treatment of portal hypertension by surgical or interventional shunt procedures weight gain and improvement in the nutritional status have been reported repeatedly [7], [8], [9], [10]. In cirrhosis, however, the precise assessment of nutritional state is complicated by water retention [11]. Recently, Selberg and coworkers [6] found that the reduction in preoperative body cell mass was a relevant predictor of a less favourable outcome of liver transplantation.
In a prospective study we therefore assessed the evolution of body composition, energy expenditure, nutrient intake, as well as mental state over periods of 6 and 12 months after a transjugular intrahepatic portosystemic stent-shunt (TIPS) had been inserted [12]. As a reference body cell mass estimated by bioelectrical impedance analysis and resting energy expenditure were determined in healthy controls, too. Specifically, we were interested to see: (1) whether the weight gain following TIPS was associated with an increase in the metabolically relevant compartments muscle mass or body cell mass as assessed by two independent methods; and (2) whether patients with TIPS do tolerate a diet according to the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines [1] without adverse effects on mental state.
Section snippets
Patients
Twenty-one patients (13 men, eight women; age: 60.0 (38.7–71.6) years) with liver cirrhosis of alcoholic (n=19) or non-alcoholic (one autoimmune hepatitis, one primary biliary cirrhosis) origin were studied prospectively before and 6.0 (5.0–7.4) months as well as 12.5 (11.8–14.9) months after TIPS insertion. The indications for TIPS insertion were recurrent esophageal variceal bleeding in 14 patients (nine without ascites and five with ascites) and refractory ascites in seven patients. The
Results
TIPS was well tolerated by all patients. Among the 14 patients in whom TIPS was performed for treatment of variceal hemorrhage, there was one episode of variceal bleeding within the first 6 months and one at month 9 due to TIPS occlusion which required a surgical shunt procedure as compared to 4 (0–10) episodes in the year prior to TIPS (P<0.001) and ascites was absent (n=4) or moderate (n=1) in the five patients who also had ascites prior to TIPS. Ascites improved significantly in all seven
Body composition
In this prospective study we demonstrated that body cell mass in patients with liver cirrhosis is severely reduced and this condition does not inevitably run a downhill course but can be ameliorated as demonstrated in a patient cohort treated with TIPS. Using three independent methods (anthropometry, bioelectrical impedance analysis, total body potassium counting) to analyse body composition we could not only confirm the repeatedly claimed improvement in nutritional state after successful
References (39)
- et al.
ESPEN guidelines for nutrition in liver disease and transplantation
Clin Nutr
(1997) - et al.
Malnutrition in alcoholic and virus-related cirrhosis
Am J Clin Nutr
(1996) - et al.
The natural history of portal hypertension after transjugular intrahepatic portosystemic shunts
Gastroenterology
(1997) - et al.
Transjugular intrahepatic portosystemic shunt (TIPS) in patients with refractory ascites: effect on body weight and Child-Pugh score
Am J Gastroenterol
(1998) - et al.
Early detection of protein depletion in alcoholic cirrhosis: role of body composition analysis
Gastroenterology
(1993) New standards of weight and body composition by frame size and height for assessment of nutritional status of adults and the elderly
Am J Clin Nutr
(1984)- et al.
Anthropometric measurement of muscle mass: revised equations for calculating bone-free arm muscle area
Am J Clin Nutr
(1982) - et al.
Bioelectrical impedance analysis is a useful bedside technique to assess malnutrition in cirrhotic patients with and without ascites
Hepatology
(2000) - et al.
Estimation of total body water by bioelectrical impedance analysis
Am J Clin Nutr
(1986) - et al.
Validation and comparison of two computerized methods of obtaining a diet history
Clin Nutr
(1998)
Magnitude of body cell mass depletion and the timing of death from wasting in AIDS
Am J Clin Nutr
Clinical significance and correlates of whole body potassium status in patients with liver cirrhosis
Hepatol Res
Effects of ascites resolution after successful TIPS on nutrition in cirrhotic patients with refractory ascites
Am J Gastroenterol
Ascites increases the resting energy expenditure in liver cirrhosis
Gastroenterology
Reexamination of the relationship of resting metabolic rate to fat-free mass and to the metabolically active components of fat-free mass in humans
Am J Clin Nutr
Effect of total enteral nutrition on the short-term outcome of severely malnourished cirrhotics. A randomized controlled trial
Gastroenterology
Accelerated improvement of alcoholic liver disease with enteral nutrition
Gastroenterology
A study of oral nutritional support with oxandrolone in malnourished patients with alcoholic hepatitis: results of a department of veterans affairs cooperative study
Hepatology
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