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Determining energy needs is important to avoid either weight loss or weight gain especially for people with medical conditions such as hepatitis. This article builds upon the information offered in previously published HIV ReSource Review issues. It concentrates on the energy needs of people with hepatitis and liver disease.
Weight Loss And Malnutrition
Weight loss and subsequent malnutrition is common in people with hepatitis particularly those with advanced liver disease. Basal energy expenditure (BEE - also commonly referred to as resting energy expenditure) remains chronically elevated in cirrhosis leading to a progressive loss of muscle and fat mass and subsequent protein energy malnutrition. (1)
Preliminary studies found
BEE similar in cirrhotic patients and controls, with significant correlations
between energy production rate, body weight and fat-free mass. Cirrhotic
patients with poor nutritional status and reduced lean tissue mass showed
a lower energy production rate. The pattern of fuel use in cirrhosis resembles
that in starvation but investigators did not notice significant changes
in energy metabolism in acute hepatitis. (2) In another small preliminary
study, Green et al reported elevated resting metabolic rate (RMR) in patients
with primary biliary cirrhosis as compared with post-liver-transplantation
patients and control subjects. (3)
Protein energy malnutrition
is common in both alcoholic and nonalcoholic cirrhotics but is more pronounced
in nonalcoholic cirrhotics. (4) Cirrhotics with decreased body cell mass
expend more energy at rest even though their overall energy expenditure
appears equal to that of healthy controls. Selberg and colleagues report
that hypermetabolism along with a poor nutritional state adversely affects
survival after liver transplantation. (5)
Although Muller and colleagues reported that hypermetabolism was not a constant feature of cirrhosis (6), cirrhotic patients frequently have clinical signs of hypermetabolism that may cause malnutrition and contribute to clinical outcome. (1, 3, 5-8) Eighteen percent of the patients in Muller's study group were hypermetabolic. (6) BEE was closely related to fat-free mass as in earlier studies and increased BEE was associated with significant losses of muscle, body cell mass, and extracellular mass. Thirty-one percent of the patients were hypometabolic with increased fat and fat-free mass. Increased lipid oxidation and reduced glucose oxidation was most pronounced in patients with advanced stages of liver disease.
