This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Mendenhall, C. L. Search for Related Content PubMed PubMed Citation Articles by Mendenhall, C. L. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Medline Plus Health Information Anabolic Steroids Diets Hazardous Substances DB OXANDROLONE Social Bookmarking                         What's this?

Protein Energy Malnutrition in Severe Alcoholic Hepatitis: Diagnosis and Response to Treatment

Department of Veterans Affairs Medical Centers: Cincinnati, Ohio

Thomas E. Moritz, MS

Hines, Illinois

Gary A. Roselle, MD

Department of Veterans Affairs Medical Centers: Cincinnati, Ohio

Timothy R. Morgan, MD

Long Beach, California

Bernard A. Nemchausky, MD

Hines, Illinois

Carlo H. Tamburro, MD

Louisville, Kentucky

Eugene R. Schiff, MD

Miami, Florida

Craig J. Mcclain, MD

Lexington, Kentucky

Luis S. Marsano, MD

Lexington, Kentucky

John I. Allen, MD

Minneapolis, Minnesota

Arun Samanta, MD

East Orange, New Jersey

Robert E. Weesner, MD

Department of Veterans Affairs Medical Centers: Cincinnati, Ohio

William G. Henderson, PHD

Hines, Illinois

Thomas S. Chen, MD

East Orange, New Jersey

Samuel W. French, MD

Harbor UCLA Medical Center, Torrance, California

Antonio Chedid, MD

Hines, Illinois

THE VA COOPERATIVE STUDY GROUP #275

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. (Journal of Parenteral and Enteral Nutrition 19:258-265, 1995)

Journal of Parenteral and Enteral Nutrition, Vol. 19, No. 4, 258-265 (1995)
DOI: 10.1177/0148607195019004258


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				E. Gonzalez-Reimers, E. Garcia-Valdecasas-Campelo, F. Santolaria-Fernandez, M. J. Sanchez-Perez, E. Rodriguez-Rodriguez, M. A. Gomez-Rodriguez, and J. Vina-Rodriguez Prognostic Value of Nutritional Status in Alcoholics, Assessed by Double-Energy X-Ray Absorptiometry Alcohol Alcohol., February 29, 2008; (2008) agn011v1. [Abstract] [Full Text] [PDF]

				A. J. Hanje, B. Fortune, M. Song, D. Hill, and C. McClain The Use of Selected Nutrition Supplements and Complementary and Alternative Medicine in Liver Disease Nutr Clin Pract, June 1, 2006; 21(3): 255 - 272. [Abstract] [Full Text] [PDF]

				M. Charlton Branched-Chain Amino Acid Enriched Supplements as Therapy for Liver Disease J. Nutr., January 1, 2006; 136(1): 295S - 298S. [Abstract] [Full Text] [PDF]

				E. G. Boyce Use and Effectiveness of Performance-Enhancing Substances Journal of Pharmacy Practice, February 1, 2003; 16(1): 22 - 36. [Abstract] [PDF]

				F. R. Sattler, E. T. Schroeder, M. P. Dube, S. V. Jaque, C. Martinez, P. J. Blanche, S. Azen, and R. M. Krauss Metabolic effects of nandrolone decanoate and resistance training in men with HIV Am J Physiol Endocrinol Metab, December 1, 2002; 283(6): E1214 - E1222. [Abstract] [Full Text] [PDF]

				C. P. Earthman, J. R. Matthie, P. M. Reid, I. T. Harper, E. Ravussin, and W. H. Howell A comparison of bioimpedance methods for detection of body cell mass change in HIV infection J Appl Physiol, March 1, 2000; 88(3): 944 - 956. [Abstract] [Full Text] [PDF]

				A. S. Dobs Is There a Role for Androgenic Anabolic Steroids in Medical Practice? JAMA, April 14, 1999; 281(14): 1326 - 1327. [Full Text] [PDF]

				R. A Richardson, H I. Davidson, A. Hinds, S. Cowan, P. Rae, and O J. Garden Influence of the metabolic sequelae of liver cirrhosis on nutritional intake Am. J. Clinical Nutrition, February 1, 1999; 69(2): 331 - 337. [Abstract] [Full Text] [PDF]