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Malnutrition and diabetes mellitus are related to hepatic encephalopathy in patients with liver cirrhosis.
Liver Int 2007; 27(9):1194-201LI

Abstract

BACKGROUND/AIMS

Studies on animal models of hepatic encephalopathy (HE) suggest that poor nutritional status may facilitate the development of HE. Insulin resistance and diabetes mellitus have recently been reported to affect cognition in patients with hepatitis C cirrhosis awaiting liver transplantation. Our aim was to investigate the effects of malnutrition and diabetes mellitus on HE in unselected patients with liver cirrhosis.

METHODS

A total of 128 consecutive cirrhotic patients were prospectively evaluated for the presence of HE according to the West-Haven criteria as well as by means of two psychometric tests and fasting plasma ammonium ion concentrations. Nutritional status was assessed by anthropometry and estimation of recent weight change. Fasting plasma glucose was measured, and in a subgroup of 84 patients fasting serum insulin and insulin resistance were also determined.

RESULTS

Fifty-one (40%) cirrhotics were malnourished, 33 (26%) had diabetes and 42 (34%) had HE. Patients with vs. without malnutrition had more frequently HE (46 vs. 27%; P=0.031) but did not differ in age, aetiology or severity of liver cirrhosis (P>0.1). Multivariate analysis showed that the time needed to perform number connection test A was independently correlated to age, the Child-Pugh score, diabetes and malnutrition (P<0.05 for all). Plasma ammonium ion levels were related to insulin resistance (r=0.42, P<0.001) and muscle mass (r=0.28, P=0.003).

CONCLUSION

Malnutrition and diabetes mellitus seem to be related to HE in patients with liver cirrhosis. Nutritional status and insulin resistance might be implicated in the pathogenesis of HE.

Authors+Show Affiliations

Section of Gastroenterology and Hepatology, Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden. evangelos.kalaitzakis@vgregion.seNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17919230

Citation

Kalaitzakis, Evangelos, et al. "Malnutrition and Diabetes Mellitus Are Related to Hepatic Encephalopathy in Patients With Liver Cirrhosis." Liver International : Official Journal of the International Association for the Study of the Liver, vol. 27, no. 9, 2007, pp. 1194-201.
Kalaitzakis E, Olsson R, Henfridsson P, et al. Malnutrition and diabetes mellitus are related to hepatic encephalopathy in patients with liver cirrhosis. Liver Int. 2007;27(9):1194-201.
Kalaitzakis, E., Olsson, R., Henfridsson, P., Hugosson, I., Bengtsson, M., Jalan, R., & Björnsson, E. (2007). Malnutrition and diabetes mellitus are related to hepatic encephalopathy in patients with liver cirrhosis. Liver International : Official Journal of the International Association for the Study of the Liver, 27(9), pp. 1194-201.
Kalaitzakis E, et al. Malnutrition and Diabetes Mellitus Are Related to Hepatic Encephalopathy in Patients With Liver Cirrhosis. Liver Int. 2007;27(9):1194-201. PubMed PMID: 17919230.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Malnutrition and diabetes mellitus are related to hepatic encephalopathy in patients with liver cirrhosis. AU - Kalaitzakis,Evangelos, AU - Olsson,Rolf, AU - Henfridsson,Pia, AU - Hugosson,Irene, AU - Bengtsson,Maria, AU - Jalan,Rajiv, AU - Björnsson,Einar, PY - 2007/10/9/pubmed PY - 2008/1/30/medline PY - 2007/10/9/entrez SP - 1194 EP - 201 JF - Liver international : official journal of the International Association for the Study of the Liver JO - Liver Int. VL - 27 IS - 9 N2 - BACKGROUND/AIMS: Studies on animal models of hepatic encephalopathy (HE) suggest that poor nutritional status may facilitate the development of HE. Insulin resistance and diabetes mellitus have recently been reported to affect cognition in patients with hepatitis C cirrhosis awaiting liver transplantation. Our aim was to investigate the effects of malnutrition and diabetes mellitus on HE in unselected patients with liver cirrhosis. METHODS: A total of 128 consecutive cirrhotic patients were prospectively evaluated for the presence of HE according to the West-Haven criteria as well as by means of two psychometric tests and fasting plasma ammonium ion concentrations. Nutritional status was assessed by anthropometry and estimation of recent weight change. Fasting plasma glucose was measured, and in a subgroup of 84 patients fasting serum insulin and insulin resistance were also determined. RESULTS: Fifty-one (40%) cirrhotics were malnourished, 33 (26%) had diabetes and 42 (34%) had HE. Patients with vs. without malnutrition had more frequently HE (46 vs. 27%; P=0.031) but did not differ in age, aetiology or severity of liver cirrhosis (P>0.1). Multivariate analysis showed that the time needed to perform number connection test A was independently correlated to age, the Child-Pugh score, diabetes and malnutrition (P<0.05 for all). Plasma ammonium ion levels were related to insulin resistance (r=0.42, P<0.001) and muscle mass (r=0.28, P=0.003). CONCLUSION: Malnutrition and diabetes mellitus seem to be related to HE in patients with liver cirrhosis. Nutritional status and insulin resistance might be implicated in the pathogenesis of HE. SN - 1478-3223 UR - https://www.unboundmedicine.com/medline/citation/17919230/Malnutrition_and_diabetes_mellitus_are_related_to_hepatic_encephalopathy_in_patients_with_liver_cirrhosis_ L2 - https://doi.org/10.1111/j.1478-3231.2007.01562.x DB - PRIME DP - Unbound Medicine ER -