Macronutrient preference, dietary intake, and substrate oxidation among stable cirrhotic patients

Anorexia in liver disease is common; however, its association with aberrant metabolism and the type of cirrhosis has not been considered. Dietary intake, nutritional status, fasting substrate oxidation, and macronutrient preference were examined in controls (n = 18) and 65 patients with hepatocellular (n = 31) or biliary cirrhosis (n = 34). Energy intakes were lowest in hepatocellular patients (controls: 9.0 +/- 0.48 megajoules/day compared with biliary: 7.0 +/- 0.40 MJ/day, P <.05; controls compared with hepatocellular 6.5 +/- 0.39 megajoules/day, P <.01). Triceps skinfold was lower only in hepatocellular patients (controls: 109 +/- 9.2% compared with hepatocellular 79 +/- 5.6%, P <.05). The fasting rate of lipid oxidation was elevated in hepatocellular patients when compared with controls and biliary patients (controls: 40.9 +/- 15.1 mg/min compared with hepatocellular 62.8 +/- 16.8 mg/min, P <.001, and biliary : 45.5 +/- 17.0 mg/min compared with hepatocellular, P <.001). Control subjects exhibited a greater preference for the high fat, moderate carbohydrate food (controls: median 7.0 IQR 2.0 compared with biliary: median 5.0 interquartile range [IQR] 4.7, P <.01) (controls compared with hepatocellular: median 6.0 IQR 4.0, P <.01). Cirrhotic patients' spontaneous dietary intake is lower than that of controls and recommended intakes. Although macronutrient preference ratings were different within cirrhotic patient groups it remains unclear whether associated nutrient deficits are metabolically driven and dictated by primary cause.