Resting energy expenditure in diabetic and nondiabetic patients with liver cirrhosis: Relation with insulin sensitivity and effect of liver transplantation and immunosuppressive therapy

Gianluca Perseghin, Vincenzo Mazzaferro, Stefano Benedini, Andrea Pulvirenti, Jorgelina Coppa, Enrico Regalia, Livio Luzi

Research output: Contribution to journalArticle

Abstract

Background: Hypermetabolism, insulin resistance, and diabetes are common in patients with liver cirrhosis. Objective: We assessed whether diabetes and insulin resistance influence postabsorptive energy homeostasis in these patients and whether liver transplantation (LTx) and immunosuppressive drugs affect these relations. Design: Twenty-six patients with liver cirrhosis (16 with and 10 without diabetes) were studied with an insulin clamp and indirect calorimetry. Eleven of these subjects were studied 9 mo after LTx to longitudinally assess its effects. To cross-sectionally explore a longer follow-up period, we studied 65 patients 6, 14, and 32 mo after LTx. Seven patients with chronic uveitis (receiving immunosuppressive therapy) and 20 healthy subjects served as control subjects. Results: Diabetic and nondiabetic patients with cirrhosis had insulin resistance (SI(clamp); P <0.03) and higher measured resting energy expenditure (REE) as a percentage of predicted REE than did healthy subjects (107.6 ± 1.8% compared with 97.4 ± 2.3%; P <0.03), and these 2 alterations were associated (R2 = 0.119, P = 0.0002). The longitudinal study showed an improvement in the 2 variables after LTx, but full restoration was not achieved. The cross-sectional analysis confirmed this observation in patients studied 6 mo (n = 28) after LTx. In patients studied 14 (n = 21) and 32 mo (n = 16) after LTx, SI(clamp) and measured REE as a percentage of predicted REE were not significantly different from those in control subjects. Conclusions: In patients with liver cirrhosis, higher-than-normal postabsorptive REE was associated with insulin resistance regardless of diabetes. This abnormality persisted in patients studied 6-9 mo after LTx but improved simultaneously with the improvement in insulin sensitivity thereafter.

Original languageEnglish
Pages (from-to)541-548
Number of pages8
JournalAmerican Journal of Clinical Nutrition
Volume76
Issue number3
Publication statusPublished - Sep 2002

Keywords

  • Diabetes
  • Immunosuppressive therapy
  • Insulin resistance
  • Lipid oxidation
  • Liver cirrhosis
  • Liver transplantation
  • Resting energy expenditure

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Food Science

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