Anne Wilkens Knudsen1, Aleksander Krag2, Inge Nordgaard-Lassen1, Erik Frandsen3, Flemming Tofteng1, Christian Mortensen1, Ulrik Becker1,4. 1. a Gastrounit, Medical Division , Copenhagen University Hospital Hvidovre , Hvidovre , Denmark ; 2. b Department of Gastroenterology and Hepatology , Odense University Hospital, University of Southern Denmark , Odense , Denmark ; 3. c Department of Diagnostics, Clinical Physiology and Nuclear Medicine Section , Copenhagen University Hospital Glostrup , Glostrup , Denmark ; 4. d National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.
Abstract
OBJECTIVE: Patients with decompensated cirrhosis often suffer from malnutrition. To enable appropriate nutritional supplementation a correct estimation of resting energy expenditure (REE) is needed. It is, however, unclear whether the volume of ascites should be included or not in the calculations of the REE. MATERIAL AND METHODS: In 19 patients with cirrhosis and ascites, measurements of REE by indirect calorimetry were performed before paracentesis, after paracentesis, and four weeks after paracentesis. Moreover, handgrip strength (HGS), dual X-ray absorptiometry (DXA), and biochemistry were assessed. RESULTS: Calculated and measured REE differed more than 10% in 63% of the patients at baseline. By including the weight of ascites in the calculation of REE, the REE was overestimated by 283 (-602-1381) kJ/day (p = 0.69). By subtracting the weight of ascites in the calculation of REE, it was underestimated by -379 (-1915 - 219) kJ/day, (p = 0.06). Patients in whom measured REE decreased after paracentesis had higher middle arterial pressure (MAP) (p = 0.02) and p-sodium (p = 0.02) at baseline. Low HGS (M: <30 kg; W < 20 kg) was evident in 68% of the patients. T-scores revealed osteopenia and osteoporosis in 58% and 16%, respectively. Reduced vitamin D levels (<50 nmol/l) were found in 68%. CONCLUSIONS: The presence of ascites seems to increase REE, why we suggest that when REE is calculated, the weight of ascites should be included. Indirect calorimetry is, however, preferable for REE estimation. More than two-third of patients with ascites suffer from muscle weakness and/or osteopenia.
OBJECTIVE:Patients with decompensated cirrhosis often suffer from malnutrition. To enable appropriate nutritional supplementation a correct estimation of resting energy expenditure (REE) is needed. It is, however, unclear whether the volume of ascites should be included or not in the calculations of the REE. MATERIAL AND METHODS: In 19 patients with cirrhosis and ascites, measurements of REE by indirect calorimetry were performed before paracentesis, after paracentesis, and four weeks after paracentesis. Moreover, handgrip strength (HGS), dual X-ray absorptiometry (DXA), and biochemistry were assessed. RESULTS: Calculated and measured REE differed more than 10% in 63% of the patients at baseline. By including the weight of ascites in the calculation of REE, the REE was overestimated by 283 (-602-1381) kJ/day (p = 0.69). By subtracting the weight of ascites in the calculation of REE, it was underestimated by -379 (-1915 - 219) kJ/day, (p = 0.06). Patients in whom measured REE decreased after paracentesis had higher middle arterial pressure (MAP) (p = 0.02) and p-sodium (p = 0.02) at baseline. Low HGS (M: <30 kg; W < 20 kg) was evident in 68% of the patients. T-scores revealed osteopenia and osteoporosis in 58% and 16%, respectively. Reduced vitamin D levels (<50 nmol/l) were found in 68%. CONCLUSIONS: The presence of ascites seems to increase REE, why we suggest that when REE is calculated, the weight of ascites should be included. Indirect calorimetry is, however, preferable for REE estimation. More than two-third of patients with ascites suffer from muscle weakness and/or osteopenia.
Authors: Shaiane Ferreira; Cláudio Augusto Marroni; Jessica Taina Stein; Roberta Rayn; Ana Cristhina Henz; Natália P Schmidt; Randhall B Carteri; Sabrina Alves Fernandes Journal: World J Hepatol Date: 2022-04-27
Authors: Nikolaj Torp; Mads Israelsen; Bjørn Madsen; Philipp Lutz; Christian Jansen; Christian Strassburg; Christian Mortensen; Anne Wilkens Knudsen; Grith Lykke Sorensen; Uffe Holmskov; Anders Schlosser; Maja Thiele; Jonel Trebicka; Aleksander Krag Journal: JHEP Rep Date: 2021-08-27
Authors: Nikolaj Torp; Mads Israelsen; Bjørn Madsen; Philipp Lutz; Christian Jansen; Christian Strassburg; Christian Mortensen; Anne Wilkens Knudsen; Grith Lykke Sorensen; Uffe Holmskov; Anders Schlosser; Maja Thiele; Jonel Trebicka; Aleksander Krag Journal: JHEP Rep Date: 2021-03-29