Elsevier

Hepatology Research

Volume 30, Supplement, December 2004, Pages 67-72
Hepatology Research

Late evening snack and the change of blood glucose level in patients with liver cirrhosis

https://doi.org/10.1016/j.hepres.2004.10.010Get rights and content

Abstract

It has been reported that patients with liver cirrhosis suffer from energy malnutrition and late evening snacks (LES) can be effective for this malnutrition. On the other hand, it is also known that some patients with liver cirrhosis have glucose intolerance as a complication. We have shown that 1 week LES treatment using as an oral supplement with branched chain amino acids significantly reduced an increase of blood glucose level after meals. Fat oxidation rate was significantly decreased with an increased carbohydrate oxidation rate. LES may improve glucose intolerance in patients with liver cirrhosis, at least hospitalized patients.

Introduction

It has been reported that patients with liver cirrhosis usually have the protein-energy malnutrition (PEM) [1], [2]. A clinical investigation on nutritional metabolism in patients with liver cirrhosis, using an indirect calorimeter showed decreased nocturnal glucose oxidation causing fat and protein catabolism [3]. As an attempt to improve the state of energy malnutrition, late evening snacks (LES) have been developed and improved energy substrate metabolism has been reported [4], [5], [6], [7], [8]. On the other hand, it has been reported that glucose intolerance is found in approximately 70% of patients with liver cirrhosis, and in about 40% of those with diabetes [9].

Section snippets

Liver cirrhosis and glucose intolerance

Patients with liver cirrhosis often have hyperinsulinemia and a blunted insulin secretion response in the face of hyperglycemia, suggesting the presence of impaired glucose tolerance [9]. In these patients, post-prandial glucose uptake is thought not to be carried out promptly in insulin-sensitive tissues such as skeletal muscle and also glycogen synthesis is not promoted in skeletal muscle or the liver. It is well established that glycogen contents in the liver and skeletal muscle of cirrhotic

Change of energy metabolism of liver cirrhosis

Patients with liver cirrhosis have increased fat oxidation and reduced carbohydrate oxidation compared to those of healthy patients [3]. However, although glucose oxidation is retarded, cirrhotic patients show increased carbohydrate oxidation after glucose supplement [12].

Thus, we investigated the effect of a BCAA-enriched nutritional supplement as a late evening snack and examined the effect of LES on the blood glucose level (the effect on hyperglycemia after the meal) and energy metabolism

Effect of LES on the change of the blood glucose level

To examine the effect of LES on the blood glucose level, the study was performed on 11 patients with liver cirrhosis hospitalized in our hospital.

Examination was carried out when the patients were in stable condition without complications at least 1 week after admission. Upon examination prior to LES supplementation, patients fasted for at least 12 h and rested in bed until indirect calorimetry (a CALORIE SCALE, Chest MI) was finished. With measured oxygen consumption per minute (VO2), carbon

Effect of LES on metabolic rate and BTR

Typical change of metabolism with glucose, fat and protein of one patient with liver cirrhosis was shown in Fig. 3. One week LES-administration clearly improved glucose oxidation in this case. With all patients, the value of npRQ increased significantly after 1-week LES administration (0.81 ± 0.02 versus 0.77 ± 0.01, P < 0.05). The fat oxidation rate as an energy substrate decreased significantly (54.1 ± 5.2 versus 66.2 ± 4.0, P < 0.05) with the increase of the glucose oxidation rate (33.2 ± 4.6 versus 22.2 ± 

Conclusion and further prospects

A recent report [21] indicates that leucine promotes glucose uptake via PKC and PI3-kinase, not mTOR signals as well as glycogen synthesis via mTOR activation in muscles. The report also shows that leucine or isoleucine administration, but not valine, significantly improves glucose tolerance in oral glucose tolerance test (OGTT) in CCl4 rats [22]. Thus, improvement of hyperglycemia after the administration of LES may due to the effect of leucine and isoleucine in a BCAA-enriched supplement used

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