Effect of a late evening meal on nitrogen balance in patients with cirrhosis of the liver.

Abstract

OBJECTIVE--To assess whether a late evening meal would improve nitrogen balance in patients with cirrhosis of the liver. DESIGN--Randomised crossover study of meal schedules comparing three meals a day with four or six meals a day, the four and six meal schedules both including a late evening meal (2300). SETTING--Metabolic ward. PATIENTS--Seven men and two women aged 34-66 with cirrhosis of the liver (Child's grade B). INTERVENTIONS--Patients spent two seven day periods in the ward. For five days of each period they received, in random order, isonitrogenous isocaloric diets supplied in three meals a day and in four or six meals a day. MAIN OUTCOME MEASURE--Nitrogen balance, calculated as the difference between dietary intake and the total of urinary, faecal, and integumental nitrogen loss. RESULTS--Faecal nitrogen loss was no different between three meals a day and four or six meals a day. On both four and six meals a day, however, patients had nitrogen balances that were more positive (or less negative) than on three meals a day (1.26 (SD 2.1) g/24 h v 0.26 (2.2) g/24 h, p less than 0.01). Six meals a day did not produce significantly better improvements in nitrogen balance than four meals a day. CONCLUSIONS--A late evening meal seemed to improve the efficiency of nitrogen metabolism, but longer term studies are needed to assess whether this leads to a better nutritional state.