Protein energy malnutrition in severe alcoholic hepatitis: Diagnosis and response to treatment

C. L. Mendenhall, T. E. Moritz, G. A. Roselle, T. R. Morgan, B. A. Nemchausky, C. H. Tamburro, E. R. Schiff, C. J. McClain, L. S. Marsano, Eugene R Schiff, A. Samanta, R. E. Weesner, W. G. Henderson, T. S. Chen, S. W. French, A. Chedid

Research output: Contribution to journalArticle

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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 languageEnglish
Pages (from-to)258-265
Number of pages8
JournalJournal of Parenteral and Enteral Nutrition
Volume19
Issue number4
StatePublished - Aug 7 1995

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alcoholic hepatitis
Alcoholic Hepatitis
Protein-Energy Malnutrition
protein energy malnutrition
Oxandrolone
creatinine
Creatinine
risk factors
lymphocyte count
Lymphocyte Count
Hand Strength
Muscles
muscles
therapeutics
Survival
lymphocytes
Testosterone Congeners
deterioration
Nutrition Therapy
anabolic steroids

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Food Science

Cite this

Mendenhall, C. L., Moritz, T. E., Roselle, G. A., Morgan, T. R., Nemchausky, B. A., Tamburro, C. H., ... Chedid, A. (1995). Protein energy malnutrition in severe alcoholic hepatitis: Diagnosis and response to treatment. Journal of Parenteral and Enteral Nutrition, 19(4), 258-265.

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 journalArticle

Mendenhall, CL, Moritz, TE, Roselle, GA, Morgan, TR, Nemchausky, BA, Tamburro, CH, Schiff, ER, McClain, CJ, Marsano, LS, Schiff, ER, Samanta, A, Weesner, RE, Henderson, WG, Chen, TS, French, SW & Chedid, A 1995, 'Protein energy malnutrition in severe alcoholic hepatitis: Diagnosis and response to treatment', Journal of Parenteral and Enteral Nutrition, vol. 19, no. 4, pp. 258-265.
Mendenhall CL, Moritz TE, Roselle GA, Morgan TR, Nemchausky BA, Tamburro CH et al. Protein energy malnutrition in severe alcoholic hepatitis: Diagnosis and response to treatment. Journal of Parenteral and Enteral Nutrition. 1995 Aug 7;19(4):258-265.
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. / Protein energy malnutrition in severe alcoholic hepatitis : Diagnosis and response to treatment. In: Journal of Parenteral and Enteral Nutrition. 1995 ; Vol. 19, No. 4. pp. 258-265.
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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.

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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.

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