Original Article Improvement of nutritional status in malnourished cirrhotic patients one year after liver transplantation Manuela Merli a, * , Michela Giusto a , Oliviero Riggio a , Federica Gentili a , Antonio Molinaro a , Adolfo Francesco Attili a , Stefano Ginanni Corradini a , Massimo Rossi b a II Gastroenterologia, Policlinico Umberto I, Università Sapienza di Roma, Italy b II Clinica Chirurgica, Policlinico Umberto I, Università Sapienza di Roma, Italy article info Article history: Received 29 September 2010 Accepted 5 February 2011 Keywords: Malnutrition Cirrhosis Liver transplant Insulin Diet summary Background & aims: Liver transplantation is a major procedure often undertaken in patients in poor nutritional status. Few studies have examined the modification of nutritional status after liver trans- plantation. We aimed at analyzing the modification of nutritional status occurring in liver recipients during the first year. Methods: Twenty-five consecutive patients submitted to liver transplantation were studied. A complete nutritional assessment, was performed before and at 3, 6 and 12 months after transplantation. Insulin and C-peptide plasma levels were determined and insulin sensitivity was estimated. Results: According to subjective global assessment 56% of patients were malnourished at transplant. In malnourished patients nutritional status further deteriorated at 3 months but improved 6 and 12 months after transplantation. Fat mass significantly increased from before to 12 months after transplant (median triceps skinfold: 10.8 vs 15.2 mm, p ¼ 0.03) while parameters of muscle mass showed minor variations (median arm muscle circumference: 23.4 vs 24.0 cm, p ¼ 0.3). The daily calorie intake also improved (27 vs 32 kcal/kg/die, p ¼ 0.007) and protein intake increased (0.8 vs 1.3 g/kg, p ¼ 0.02). In patients without malnutrition nutritional status and dietary intake showed minor variations after transplantation. Hyperinsulinemia was normalized and insulin sensitivity improved in all patients post-transplant. Conclusions: During the first 12 months after liver transplant a significant improvement in nutritional status is achieved in patients previously malnourished. Fat deposits show the more rapid improvement while the amelioration of muscle mass requires a longer period. The increased dietary intake and improved insulin sensitivity are associated to these changes. Ó 2011 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. 1. Introduction Orthotopic liver transplantation (LT) is a major procedure which often needs to be undertaken in patients in poor nutritional status. Malnutrition is in fact frequently associated with liver cirrhosis being its prevalence between 20 and 80% and those patients with a more advanced liver insufficiency are known to have more severe protein/calorie malnutrition. 1e4 The pathogenesis of malnutrition in chronic liver diseases is multifactorial. 5 Previous studies have examined the influence of nutritional status on the outcome after LT, showing that preoperative malnu- trition impacts negatively on post-transplantation outcome. 6e10 In a recent prospective investigation we observed that a compromised nutritional status was independently associated with the number of infection episodes, the length of stay in the intensive care unit (ICU) and the total number of days spent in the hospital after transplantation. 11 Moreover the analysis of a large database evi- denced that, among adult liver recipients, those who were trans- planted being underweight had a significantly lower survival. 12 Despite the negative role of pre-transplant malnutrition and the initial disadvantage of malnourished patients, it is conceivable that these are those who, by restoring their liver function, may obtain the greater improvement. After LT, in fact, many metabolic Abbreviations: LT, liver transplantation; ICU, intensive care unit; BW, body weight; MAC, mid-arm circumference; TSF, triceps skin fold; MAMC, mid-arm muscle circumference; SGA, subjective global nutritional assessment; REE, resting energy expenditure; TEI, daily total energy intake; TEE, daily total energy expen- diture; TEB, total energy balance; HOMA, homeostatic model assessment index. * Corresponding author. II Gastroenterologia, Dipartimento di Medicina Clinica, Viale dell’Università 37, 00185 Roma, Italy. Tel./fax: þ39 06 49972001. E-mail address: manuela.merli@uniroma1.it (M. Merli). Contents lists available at ScienceDirect e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism journal homepage: http://www.elsevier.com/locate/clnu 1751-4991/$36.00 Ó 2011 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.eclnm.2011.02.003 e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism xxx (2011) e1ee6 Please cite this article in press as: Merli M, et al., Improvement of nutritional status in malnourished cirrhotic patients one year after liver transplantation, e-SPEN, the European e-Journal of Clinical Nutrition and Metabolism (2011), doi:10.1016/j.eclnm.2011.02.003