Abstract
Purpose
Evaluation of protein intake of patients with liver cirrhosis (LC) would facilitate optimal nutritional support. However, it has never been done on the basis of urinary urea nitrogen (UUN). The aim of this study, therefore, is to determine the usefulness of the estimated protein intake (EPI) based on UUN in patients with LC.
Methods
A total of 42 patients with early-stage LC were enrolled in this study. The actual protein intake (API) was defined as the dietary protein intake (1.0 g/kg/d) plus supplementation of any enteral diets containing branched-chain amino acids (BCAA). We calculated EPI from UUN using the formula [UUN (g/d) + 0.031 × body weight (kg)] × 0.625. We examined the correlation between EPI and API, the EPI/API ratio (EAR), and the correction based on the results.
Results
A significant positive correlation was found between API and EPI (r = 0.703, p < 0.001). The EAR in all patients was 0.84 ± 0.11. EPI times 1.2 was the correction needed to adjust EAR to 1. The corrected EPI was correlated with API (r = 0.704, p < 0.001). The corrected EAR of all 42 patients was 1.01 ± 0.13.
Conclusion
In conclusion, for patients with early-stage LC, an EPI calculated from UUN may be a useful tool for optimal nutritional support. The corrected EPI would be very useful for improved monitoring of early-stage LC.
Similar content being viewed by others
References
Alberino F, Gatta A, Amodio P, et al. Nutrition and survival in patients with liver cirrhosis. Nutrition 2001;17:445–50.
Tajika M, Kato M, Mohri H, et al. Prognostic value of energy metabolism in patients with liver cirrhosis. Nutrition 2002;18:229–34.
Moriwaki H, Miwa Y, Tajika M, et al. Branched-chain amino acids as a protein- and energy-source in liver cirrhosis. Biochem Biophys Res Commum 2004;313:405–9.
Selberg O, Bottcher J, Tusch G, et al. Identification of high- and low-risk patients before liver transplantation: a prospective cohort study of nutritional and metabolic in 150 patients. Hepatology 1997;25:652–7.
Plauth M, Carbé E, Riggio O, et al. ESPEN guidelines on enteral nutrition: liver disease. Clin Nutr 2006;25:285–94.
Friedman LS. Cirrhosis liver, biliary tract, & pancreas. In: Tierney LM, McPhee SJ, Paradakis MA, editors. 2006 Current medical diagnosis & treatment. 45th ed. New York: McGraw-Hill; 2005. p. 668–74.
Chung RT, Podolsky DK. Hepatic encephalopathy cirrhosis and its complication disorders of the gastrointestinal system. In: Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Harrison’s principles of internal medicine. 16th ed. New York: McGraw-Hill; 2005. p. 1867–9.
Riordan SM, Williams R. Treatment of hepatic encephalopathy. N Engl J Med 1997;337:473–9.
Okamoto M, Sakaida I, Tsuchiya M. Effect of a late evening snack on the blood glucose level and energy metabolism in patients with liver cirrhosis. Hepatol Res 2003;27:45–50.
Sako K, Imamura Y, Nishimata H. Branched-chain amino acids supplements in the late evening decrease the frequency of muscle cramps with advanced hepatic cirrhosis. Hepatol Res 2003;26:327–9.
Kawamura N, Nakajima H, Takashi SI. Administration of granulated BCAA, quality of life. Hepatol Res 2004;30S:42–45.
Maroni BJ, Steinman TI, Mitch WE. A method for estimating nitrogen intake of patients with chronic renal failure. Kidney Int 1985;27:58–65.
Hellerstein MK, Munro HN. Liver cirrhosis. In: Arias IM, Boyer JI, et al. editors. The liver, biology and pathobiology. 3rd ed. New York: Raven Press; 1994. p. 1169–91.
Cabre E, Gonzalez-Huix F, Abad-Lacruz A, et al. Effect of total enteral nutrition on the short-term outcome of severely malnourished cirrhotics. A randomized controlled trial. Gastroenterology 1990;98:715–20.
Sato S, Watanabe A, Muto Y, et al. for the LIV-EN Study Group. Clinical comparison of branched-chain amino acid (l-leucine, l-isoleucine, l-valine) granules and oral nutrition for hepatic insufficiency in patients with decompensated liver cirrhosis (LIV-EN study). Hepatol Res 2005;31:232–40.
Marchesini G, Bianchi G, Merli M, et al. Italian BCAA Study Group. Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial. Gastroenterology 2003;124:1792–801.
Muto Y, Sato S, Watanabe A, et al. Effects of oral branched-chain amino acid granules on event-free survival in patients with liver cirrhosis. Clin Gastroenterol Hepatol 2005;3:705–13.
Tsuchiya M, Sakaida I, Okamoto M. The effect of a late evening snack in patients with liver cirrhosis. Hepatol Res 2005;31:95–103.
Nishiguchi S, Habu D. Effect of oral supplementation with branched-chain amino acid granules in the early stage of cirrhosis. Hepatol Res 2004;30S:36–41.
Suzuki K, Kato A, Iwai M. Branched-chain amino acid treatment in patients with liver cirrhosis. Hepatol Res 2004;30S:25–29.
Acknowledgments
We thank Brent Bell for reading the manuscript.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Kida, Y., Ueda, H., Tanaka, H. et al. Estimation of protein intake using urinary urea nitrogen in patients with early-stage liver cirrhosis. Hepatol Int 1, 382–386 (2007). https://doi.org/10.1007/s12072-007-9019-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12072-007-9019-0