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

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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

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immunosuppressive agents
liver transplant
resting energy expenditure
liver cirrhosis
Immunosuppressive Agents
insulin resistance
Liver Cirrhosis
Liver Transplantation
Energy Metabolism
Insulin Resistance
therapeutics
diabetes
Therapeutics
Healthy Volunteers
Indirect Calorimetry
Uveitis
calorimetry
longitudinal studies
cross-sectional studies
Longitudinal Studies

Keywords

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

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Food Science

Cite this

@article{d8fb653cb6094f2d9a405a13b8a034a9,
title = "Resting energy expenditure in diabetic and nondiabetic patients with liver cirrhosis: Relation with insulin sensitivity and effect of liver transplantation and immunosuppressive therapy",
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.",
keywords = "Diabetes, Immunosuppressive therapy, Insulin resistance, Lipid oxidation, Liver cirrhosis, Liver transplantation, Resting energy expenditure",
author = "Gianluca Perseghin and Vincenzo Mazzaferro and Stefano Benedini and Andrea Pulvirenti and Jorgelina Coppa and Enrico Regalia and Livio Luzi",
year = "2002",
month = "9",
language = "English",
volume = "76",
pages = "541--548",
journal = "American Journal of Clinical Nutrition",
issn = "0002-9165",
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TY - JOUR

T1 - Resting energy expenditure in diabetic and nondiabetic patients with liver cirrhosis

T2 - Relation with insulin sensitivity and effect of liver transplantation and immunosuppressive therapy

AU - Perseghin, Gianluca

AU - Mazzaferro, Vincenzo

AU - Benedini, Stefano

AU - Pulvirenti, Andrea

AU - Coppa, Jorgelina

AU - Regalia, Enrico

AU - Luzi, Livio

PY - 2002/9

Y1 - 2002/9

N2 - 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.

AB - 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.

KW - Diabetes

KW - Immunosuppressive therapy

KW - Insulin resistance

KW - Lipid oxidation

KW - Liver cirrhosis

KW - Liver transplantation

KW - Resting energy expenditure

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C2 - 12197997

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VL - 76

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JO - American Journal of Clinical Nutrition

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SN - 0002-9165

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