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Although the incidence
of obesity-related steatosis is increasing (9), malnutrition continues
to be common in people with chronic liver disease (10) especially in those
with alcoholic hepatitis. (11) Investigators speculate that metabolic defects,
such as hypermetabolism, increased lipid utilization, and insulin resistance,
may precede and possibly lead to malnutrition in liver disease patients.
(7)
The fat cell secreted
hormone leptin may play a role in inadequate energy expenditure and malnutrition
among patients with liver cirrhosis. (12, 13) Unlike HIV-positive lipodystrophy
patients who are deficient in leptin (14), cirrhotic patients including
those with nonalcoholic steatohepatitis (NASH) have elevated serum leptin.
(12) In a study of 52 cirrhotic patients and controls with post-hepatic
liver cirrhosis, free leptin reflected fat mass. Bischoff and others note
that increased bound leptin serum concentrations are positively related
to energy expenditure and may be a useful marker for inadequate energy
expenditure in patients with liver cirrhosis. (12) Chitturi et al report
that leptin values correlated with serum c-peptide levels and with the
severity of hepatic steatosis. (13) |
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“The
fat cell secreted hormone leptin may play a role in inadequate energy expenditure
and malnutrition among patients with liver cirrhosis.”
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Sometimes prescribed
medications result in weight loss when taken by people with hepatitis.
Although anorexia and weight loss are adverse effects related to recombinant
interferon alpha (rIFN-alpha) treatment (15, 16), Gottrand and colleagues
note no deleterious effects on the growth of children. (15) Investigators
of another small study (n= 40 children) however, note that 20-weeks of
IFN-alpha therapy in children with chronic hepatitis B led to reversible
disturbances in nutritional status. (16) Treatment of hepatitis C virus
with pegylated IFN (peg-IFN) plus ribavirin in HIV-co-infected patients
(n=68) resulted in severe weight loss for 70% of the patients. (17)
Energy Needs
Various factors such as
nutritional status, genetics, gender, and diet affect total energy expenditure
(TEE – Table 1). (18) These include components such
as RMR, thermal effect of exercise and food, and facultative thermogenesis,
which is the difference in energy induced by changes in temperature, food
intake, emotional stress, and other factors.
| TABLE
1. Energy Expenditure Components |
| Factor |
Effect |
% Change |
| Nutritional status |
Starvation: Decrease |
Up to 50% |
| Thyroid function |
Increase or decrease |
40- 100% |
| Genetics |
Varies per kg of fat free mass |
~ 11% |
| Gender |
Decrease in females |
~ 10% lower |
| Fever |
Increase (per degree >98.6°F) |
7% |
| Body size |
Increase (with > wt./muscle) |
~ 6% |
| Age |
Decrease (per decade) |
~ 2-3% |
| Sympathetic nervous system |
Stress: Increase |
Varies |
| Diet |
Increased Protein: Increase |
Varies |
| Menstrual cycle |
Varies per cycle |
Varies |
| Pregnancy |
Increase |
Varies |
| Lactation |
Increase |
Varies |
|
