Abstract
Background: Active nutrition therapy and the anabolic steroid oxandrolone (OX), in selected patients with severe alcoholic hepatitis, significantly improved liver status and survival. We report here on the changes in their nutritional parameters. Methods: Protein energy malnutrition (PEM) was evaluated and expressed as percent of low normal in 271 patients initially, at 1 month and at 3 months. Active therapy consisted of OX plus a high caloric food supplement vs a matching placebo and a low calorie supplement. Results: PEM was present in every patient; mean PEM score 60% of low normal. Most of the parameters improved significantly from baseline on standard care; the largest improvement seen in visceral proteins, the smallest in fat stores (skinfold thickness). Total PEM score significantly correlated with 6 month mortality (p=.0012). Using logistic regression analysis, creatinine height index, hand grip strength and total peripheral blood lymphocytes were the best risk factors for survival. When CD lymphocyte subsets replaced total lymphocyte counts in the equation, CD8 levels became a significant risk factor (p=.004). Active treatment produced significant improvements in those parameters related to total body and muscle mass (ie, mid arm muscle area, p=.02; creatinine height index, p=.03; percent ideal body weight, p=.04). Conclusion: Deterioration in nutritional parameters is a significant risk factor for survival in severe patients with alcoholic hepatitis. This deterioration is reversible with standard hospital care. Active therapy further improves creatinine height index, mid arm muscle area and total lymphocyte counts. Hence, these later parameters appear to be the best indicators for follow-up assessments.
| Original language | English |
|---|---|
| Pages (from-to) | 258-265 |
| Number of pages | 8 |
| Journal | Journal of Parenteral and Enteral Nutrition |
| Volume | 19 |
| Issue number | 4 |
| State | Published - Aug 7 1995 |
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ASJC Scopus subject areas
- Medicine (miscellaneous)
- Food Science
Cite this
Protein energy malnutrition in severe alcoholic hepatitis : Diagnosis and response to treatment. / Mendenhall, C. L.; Moritz, T. E.; Roselle, G. A.; Morgan, T. R.; Nemchausky, B. A.; Tamburro, C. H.; Schiff, E. R.; McClain, C. J.; Marsano, L. S.; Schiff, Eugene R; Samanta, A.; Weesner, R. E.; Henderson, W. G.; Chen, T. S.; French, S. W.; Chedid, A.
In: Journal of Parenteral and Enteral Nutrition, Vol. 19, No. 4, 07.08.1995, p. 258-265.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Protein energy malnutrition in severe alcoholic hepatitis
T2 - Diagnosis and response to treatment
AU - Mendenhall, C. L.
AU - Moritz, T. E.
AU - Roselle, G. A.
AU - Morgan, T. R.
AU - Nemchausky, B. A.
AU - Tamburro, C. H.
AU - Schiff, E. R.
AU - McClain, C. J.
AU - Marsano, L. S.
AU - Schiff, Eugene R
AU - Samanta, A.
AU - Weesner, R. E.
AU - Henderson, W. G.
AU - Chen, T. S.
AU - French, S. W.
AU - Chedid, A.
PY - 1995/8/7
Y1 - 1995/8/7
N2 - Background: Active nutrition therapy and the anabolic steroid oxandrolone (OX), in selected patients with severe alcoholic hepatitis, significantly improved liver status and survival. We report here on the changes in their nutritional parameters. Methods: Protein energy malnutrition (PEM) was evaluated and expressed as percent of low normal in 271 patients initially, at 1 month and at 3 months. Active therapy consisted of OX plus a high caloric food supplement vs a matching placebo and a low calorie supplement. Results: PEM was present in every patient; mean PEM score 60% of low normal. Most of the parameters improved significantly from baseline on standard care; the largest improvement seen in visceral proteins, the smallest in fat stores (skinfold thickness). Total PEM score significantly correlated with 6 month mortality (p=.0012). Using logistic regression analysis, creatinine height index, hand grip strength and total peripheral blood lymphocytes were the best risk factors for survival. When CD lymphocyte subsets replaced total lymphocyte counts in the equation, CD8 levels became a significant risk factor (p=.004). Active treatment produced significant improvements in those parameters related to total body and muscle mass (ie, mid arm muscle area, p=.02; creatinine height index, p=.03; percent ideal body weight, p=.04). Conclusion: Deterioration in nutritional parameters is a significant risk factor for survival in severe patients with alcoholic hepatitis. This deterioration is reversible with standard hospital care. Active therapy further improves creatinine height index, mid arm muscle area and total lymphocyte counts. Hence, these later parameters appear to be the best indicators for follow-up assessments.
AB - Background: Active nutrition therapy and the anabolic steroid oxandrolone (OX), in selected patients with severe alcoholic hepatitis, significantly improved liver status and survival. We report here on the changes in their nutritional parameters. Methods: Protein energy malnutrition (PEM) was evaluated and expressed as percent of low normal in 271 patients initially, at 1 month and at 3 months. Active therapy consisted of OX plus a high caloric food supplement vs a matching placebo and a low calorie supplement. Results: PEM was present in every patient; mean PEM score 60% of low normal. Most of the parameters improved significantly from baseline on standard care; the largest improvement seen in visceral proteins, the smallest in fat stores (skinfold thickness). Total PEM score significantly correlated with 6 month mortality (p=.0012). Using logistic regression analysis, creatinine height index, hand grip strength and total peripheral blood lymphocytes were the best risk factors for survival. When CD lymphocyte subsets replaced total lymphocyte counts in the equation, CD8 levels became a significant risk factor (p=.004). Active treatment produced significant improvements in those parameters related to total body and muscle mass (ie, mid arm muscle area, p=.02; creatinine height index, p=.03; percent ideal body weight, p=.04). Conclusion: Deterioration in nutritional parameters is a significant risk factor for survival in severe patients with alcoholic hepatitis. This deterioration is reversible with standard hospital care. Active therapy further improves creatinine height index, mid arm muscle area and total lymphocyte counts. Hence, these later parameters appear to be the best indicators for follow-up assessments.
UR - http://www.scopus.com/inward/record.url?scp=0029076067&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0029076067&partnerID=8YFLogxK
M3 - Article
C2 - 8523623
AN - SCOPUS:0029076067
VL - 19
SP - 258
EP - 265
JO - Journal of Parenteral and Enteral Nutrition
JF - Journal of Parenteral and Enteral Nutrition
SN - 0148-6071
IS - 4
ER -