Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Clinical nutrition, enteral and parenteral nutrition

Effect of a carbohydrate-containing late-evening snack on energy metabolism and fasting substrate utilization in adults with acute-on-chronic liver failure due to Hepatitis B

European Journal of Clinical Nutrition volume 67, pages 1251–1256 (2013)Cite this article

Subjects

Abstract

Background/Objectives:

This study investigates the effects of a carbohydrate (CHO; lotus-root starch) predominant, late-evening snack (LES), containing 200 kcal (50 g CHO) on fasting resting energy expenditure (REE) and nutrient oxidation in hospitalized adults with acute-on-chronic liver failure (ACLF).

Subjects/Methods:

Adults with ACLF were randomized to receive daily LES (treatment; n=35) or standard care (n=35; non-supplemented control) for 14 days. REE and respiratory quotient (RQ) were measured by indirect calorimetry, nutrient oxidation (CHO, protein and fat), intake and biochemical parameters were measured in both groups at baseline and after 14 days using validated techniques. Disease severity was measured using the model for end-stage liver disease (MELD).

Results:

No significant differences in macronutrient intake, anthropometric, demographic characteristics or MELD scores were observed between groups at baseline (P>0.05). Fasting RQ was significantly higher in the LES supplemented verses the control group after 2 weeks (P=0.02). CHO oxidation was significantly higher (P=0.001) and fat oxidation (P=0.02) was lower in the LES-supplemented group when compared with controls after 2 weeks. Fasting RQ and REE in the LES-supplemented group increased significantly (0.83 verses 0.88; P=0.007/1301±409 vs 1687±718 kcal/day; P=0.02) in patients with MELD scores ⩽30 when compared with patients with MELD scores >30 (0.82 verses 0.84; P=0.27/ 1361±405 vs 1437±429 kcal/day; P=0.67) after supplementation.

Conclusions:

A carbohydrate-predominant LES is associated with increases in fasting carbohydrate oxidation, REE and reductions in fat oxidation in adults with ACLF. Therapeutic strategies utilizing LES may promote improved nutritional status in adults with ACLF.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. Polson J, Lee WM . AASLD position paper: the management of acute liver failure. Hepatology 2005; 41: 1179–1197.

    Article  Google Scholar 

  2. Liang X, Bi S, Yang W, Wang L, Cui G, Cui F et al. Epidemiological serosurvey of hepatitis B in China—declining HBV prevalence due to hepatitis B vaccination. Vaccine 2009; 27: 6550–6557.

    Article  Google Scholar 

  3. Fan HL, Yang PS, Chen HW, Chen TW, Chan DC, Chu CH et al. Predictors of the outcomes of acute-on-chronic hepatitis B liver failure. World J Gastroenterol 2012; 18: 5078–5083.

    Article  Google Scholar 

  4. Meng QH, Hou W, Yu HW, Lu J, Li J, Wang JH et al. Resting energy expenditure and substrate metabolism in patients with acute-on-chronic hepatitis B liver failure. J Clin Gastroenterol 2011; 45: 456–461.

    Article  Google Scholar 

  5. Meng QH, Wang JH, Yu HW, Li J, Feng YM, Hou W et al. Resting energy expenditure and substrate metabolism in Chinese patients with acute or chronic hepatitis B or liver cirrhosis. Intern Med 2010; 49: 2085–2091.

    Article  CAS  Google Scholar 

  6. Meng QH, Yu HW, Li J, Wang JH, Ni MM, Feng YM et al. Inadequate nutritional intake and protein-energy malnutrition involved in acute and chronic viral hepatitis Chinese patients especially in cirrhosis patients. Hepatogastroenterology 2010; 57: 845–851.

    CAS  PubMed  Google Scholar 

  7. Tsien CD, McCullough AJ, Dasarathy S . Late-evening snack: exploiting a period of anabolic opportunity in cirrhosis. J Gastroenterol Hepatol 2012; 27: 430–441.

    Article  CAS  Google Scholar 

  8. Arabi Y, Ahmed QA, Haddad S, Aljumah A, Al-Shimemeri A . Outcome predictors of cirrhosis patients admitted to the intensive care unit. Eur J Gastroenterol Hepatol 2004; 16: 333–339.

    Article  Google Scholar 

  9. Fan CL, Wu YJ, Duan ZP, Zhang B, Dong PL, Ding HG . Resting energy expenditure and glucose, protein and fat oxidation in severe chronic virus hepatitis B patients. World J Gastroenterol 2008; 14: 4365–4369.

    Article  Google Scholar 

  10. Bankhead R, Boullata J, Brantley S, Corkins M, Guenter P, Krenitsky J et al. Enteral nutrition practice recommendations. JPEN J Parenter Enteral Nutr 2009; 33: 122–167.

    Article  Google Scholar 

  11. Plauth M, Schuetz T . Hepatology—Guidelines on Parenteral Nutrition, Chapter 16. Ger Med Sci 2009; 7: Doc12.

    CAS  PubMed  PubMed Central  Google Scholar 

  12. Nakaya Y, Okita K, Suzuki K, Moriwaki H, Kato A, Miwa Y et al. BCAA-enriched snack improves nutritional state of cirrhosis. Nutrition 2007; 23: 113–120.

    Article  CAS  Google Scholar 

  13. Yamanaka-Okumura H, Nakamura T, Takeuchi H, Miyake H, Katayama T, Arai H et al. Effect of late evening snack with rice ball on energy metabolism in liver cirrhosis. Eur J Clin Nutr 2006; 60: 1067–1072.

    Article  CAS  Google Scholar 

  14. Fukushima H, Miwa Y, Ida E, Kuriyama S, Toda K, Shimomura Y et al. Nocturnal branched-chain amino acid administration improves protein metabolism in patients with liver cirrhosis: comparison with daytime administration. JPEN J Parenter Enteral Nutr 2003; 27: 315–322.

    Article  CAS  Google Scholar 

  15. Yamauchi M, Takeda K, Sakamoto K, Ohata M, Toda G . Effect of oral branched chain amino acid supplementation in the late evening on the nutritional state of patients with liver cirrhosis. Hepatol Res 2001; 21: 199–204.

    Article  CAS  Google Scholar 

  16. Zillikens MC, van den Berg JW, Wattimena JL, Rietveld T, Swart GR . Nocturnal oral glucose supplementation. The effects on protein metabolism in cirrhotic patients and in healthy controls. J Hepatol 1993; 17: 377–383.

    Article  CAS  Google Scholar 

  17. Miwa Y, Shiraki M, Kato M, Tajika M, Mohri H, Murakami N et al. Improvement of fuel metabolism by nocturnal energy supplementation in patients with liver cirrhosis. Hepatol Res 2000; 18: 184–189.

    Article  CAS  Google Scholar 

  18. Tsuchiya M, Sakaida I, Okamoto M, Okita K . The effect of a late evening snack in patients with liver cirrhosis. Hepatol Res 2005; 31: 95–103.

    Article  Google Scholar 

  19. Okamoto M, Sakaida I, Tsuchiya M, Suzuki C, Okita K . Effect of a late evening snack on the blood glucose level and energy metabolism in patients with liver cirrhosis. Hepatol Res 2003; 27: 45–50.

    Article  Google Scholar 

  20. Sarin SK, Kumar A, Almeida JA, Chawla YK, Fan ST, Garg H et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int 2009; 3: 269–282.

    Article  Google Scholar 

  21. Yang X . China food composition tables. In Yang Yuexin WY, Pan Xingchang eds. China Food Composition Tables 2nd ed Peking University Medical Press: Beijing, China, 2004.

    Google Scholar 

  22. Jyothi AN, Sheriff JT, Sajeev MS . Physical and functional properties of arrowroot starch extrudates. J Food Sci 2009; 74: E97–E104.

    Article  CAS  Google Scholar 

  23. Harris JA, Benedict FGA . Biometric Study of Human Basal Metabolism. Proc Natl Acad Sci USA 1918; 4: 370–373.

    Article  CAS  Google Scholar 

  24. Weir JB . New methods for calculating metabolic rate with special reference to protein metabolism. J Physiol 1949; 109: 1–9.

    Article  Google Scholar 

  25. Owen OE, Reichle FA, Mozzoli MA, Kreulen T, Patel MS, Elfenbein IB et al. Hepatic, gut, and renal substrate flux rates in patients with hepatic cirrhosis. J Clin Invest 1981; 68: 240–252.

    Article  CAS  Google Scholar 

  26. Lusk G . The elements of the science of nutrition. 4th edn, Philadelphia, Pennsylvannia, USA, WB Saunders Co, 1928.

  27. Wiesner R, Edwards E, Freeman R, Harper A, Kim R, Kamath P et al. Model for end-stage liver disease (MELD) and allocation of donor livers. Gastroenterology 2003; 124: 91–96.

    Article  Google Scholar 

  28. Botta F, Giannini E, Romagnoli P, Fasoli A, Malfatti F, Chiarbonello B et al. MELD scoring system is useful for predicting prognosis in patients with liver cirrhosis and is correlated with residual liver function: a European study. Gut 2003; 52: 134–139.

    Article  CAS  Google Scholar 

  29. McCullough AJ, Bugianesi E . Protein-calorie malnutrition and the etiology of cirrhosis. Am J Gastroenterol 1997; 92: 734–738.

    CAS  PubMed  Google Scholar 

  30. Koreeda C, Seki T, Okazaki K, Ha-Kawa SK, Sawada S . Effects of late evening snack including branched-chain amino acid on the function of hepatic parenchymal cells in patients with liver cirrhosis. Hepatol Res 2011; 41: 417–422.

    Article  Google Scholar 

  31. Kawamura E, Habu D, Morikawa H, Enomoto M, Kawabe J, Tamori A et al. A randomized pilot trial of oral branched-chain amino acids in early cirrhosis: validation using prognostic markers for pre-liver transplant status. Liver Transpl 2009; 15: 790–797.

    Article  Google Scholar 

  32. Okabayashi T, Nishimori I, Yamashita K, Sugimoto T, Namikawa T, Maeda H et al. Preoperative oral supplementation with carbohydrate and branched-chain amino acid-enriched nutrient improves insulin resistance in patients undergoing a hepatectomy: a randomized clinical trial using an artificial pancreas. Amino Acids 2010; 38: 901–907.

    Article  CAS  Google Scholar 

  33. Muto Y, Sato S, Watanabe A, Moriwaki H, Suzuki K, Kato A et al. Effects of oral branched-chain amino acid granules on event-free survival in patients with liver cirrhosis. Clin Gastroenterol Hepatol 2005; 3: 705–713.

    Article  CAS  Google Scholar 

  34. Moriwaki H, Shiraki M, Fukushima H, Shimizu M, Iwasa J, Naiki T et al. Long-term outcome of branched-chain amino acid treatment in patients with liver cirrhosis. Hepatol Res 2008; 38: S102–S106.

    Article  Google Scholar 

  35. Marchesini G, Bianchi G, Merli M, Amodio P, Panella C, Loguercio C et al. Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial. Gastroenterology 2003; 124: 1792–1801.

    Article  CAS  Google Scholar 

  36. Swart GR, Zillikens MC, van Vuure JK, van den Berg JW . Effect of a late evening meal on nitrogen balance in patients with cirrhosis of the liver. Bmj 1989; 299: 1202–1203.

    Article  CAS  Google Scholar 

  37. Plank LD, Gane EJ, Peng S, Muthu C, Mathur S, Gillanders L et al. Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: a randomized 12-month trial. Hepatology 2008; 48: 557–566.

    Article  Google Scholar 

  38. Marchesini G, Marzocchi R, Noia M, Bianchi G . Branched-chain amino Acid supplementation in patients with liver diseases. J Nutr 2005; 135: 1596S–1601S.

    Article  CAS  Google Scholar 

  39. Korenaga K, Korenaga M, Uchida K, Yamasaki T, Sakaida I . Effects of a late evening snack combined with alpha-glucosidase inhibitor on liver cirrhosis. Hepatol Res 2008; 38: 1087–1097.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

We acknowledge the participation of the patients in this study. Funding for this study was provided from the Foundation of Capital Medicine Development Committee (H020920020890). This work was supported by grants from the Foundation of Capital Medicine Development Committee (H020920020890).

Author information

Authors and Affiliations

  1. Department of Hepatology, Beijing You An Hospital, Capital Medical University, Beijing, China

    W Hou, J Li, J H Wang, F Y Zhang, H W Yu, J Zhang, Q W Yao, J Wu, S Y Shi & Q H Meng

  2. Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, Alberta, Canada

    J Lu & D R Mager

Authors
  1. W Hou
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J H Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. F Y Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H W Yu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Q W Yao
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. J Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. S Y Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. D R Mager
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Q H Meng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Q H Meng.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hou, W., Li, J., Lu, J. et al. Effect of a carbohydrate-containing late-evening snack on energy metabolism and fasting substrate utilization in adults with acute-on-chronic liver failure due to Hepatitis B. Eur J Clin Nutr 67, 1251–1256 (2013). https://doi.org/10.1038/ejcn.2013.163

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ejcn.2013.163

Keywords

This article is cited by

Search

Advanced search

Quick links