Chulaporn Roongpisuthipong

Nutritional assessment in various stages of liver cirrhosis

OBJECTIVES The aims of this study were to determine the prevalence of protein-calorie malnutrition, characteristics, and clinical importance of nutrition disorders in patients with liver cirrhosis according to severity of disease. METHODS Nutrition assessments such as subjective global assessment, anthropometric and biochemical measurements, immunocompentency, thiamin and riboflavin status in 60 patients with cirrhosis (33 male and 27 female) were recorded between June 1999 and December 1999 at an outpatient clinic at Ramathibodi Hospital, Bangkok, Thailand. The origin of liver disease was alcohol related in 50% of patients. Child-Pugh criteria were used to establish the severity of liver disease. RESULTS In terms of energy malnutrition, 13.3% of patients had ideal body weights below 90% and 11.7% had body mass indexes below 18.5 kg/m(2). Protein malnutrition (low albumin) and immunoincompetence (abnormal response to skin tests) were found much more frequently (45% and 22%) than energy malnutrition. Patients with alcoholic cirrhosis had ascites (P < 0.05) and hepatic encephalopathy (P < 0.001) more frequently and less triceps skinfold thickness than those with non-alcoholic cirrhosis. Subjective global assessment and serum proteins correlated with the degree of liver-function impairment, but immunologic tests correlated inversely in cirrhosis patients. Mean values for creatinine-height index, hemoglobin, cholesterol, and complement C4 showed significant decreases in severe liver failure (Child-Pugh class C) only in patients with alcoholic cirrhosis (P < 0.05). Malnutrition was correlated with the clinical severity of liver disease. CONCLUSIONS The study showed that protein-energy malnutrition is a common complication of liver cirrhosis. Nutritional disorders appeared to be related to the degree of liver injury and the etiology of nutritional disorders. Nutritional disorders were more severe with alcoholic cirrhosis than with non-alcoholic cirrhosis.

Postprandial glucose and insulin responses to various tropical fruits of equivalent carbohydrate content in non-insulin-dependent diabetes mellitus

The plasma glucose and insulin responses were determined in 10 NIDDM female patients following the ingestion of tropical fruit containing 25 g of carbohydrate. The five tropical fruits were pineapple, mango, banana, durian and rambutan. Blood was drawn at 0, 30, 60, 120 and 180 min, respectively. The results showed that the glucose-response curves to mango and banana were significantly less than those to rambutan, durian and pineapple (P less than 0.05). Only the glucose area after mango ingestion was significantly less than the glucose areas of the other fruits (P less than 0.05). The insulin response curve and insulin area after durian ingestion was statistically greater than after ingestion of the others. We concluded that after mango ingestion, the glucose area was lower than it had been after rambutan, durian and pineapple ingestion and the insulin area was lower than that after durian ingestion of equivalent carbohydrate content in type 2 (NIDDM) diabetes.

Differences between brain mass and body weight scaling to height: Potential mechanism of reduced mass-specific resting energy expenditure of taller adults

Adult resting energy expenditure (REE) scales as height( approximately 1.5), whereas body weight (BW) scales as height( approximately 2). Mass-specific REE (i.e., REE/BW) is thus lower in tall subjects compared with their shorter counterparts, the mechanism of which is unknown. We evaluated the hypothesis that high-metabolic-rate brain mass scales to height with a power significantly less than that of BW, a theory that if valid would provide a potential mechanism for height-related REE effects. The hypothesis was tested by measuring brain mass on a large (n = 372) postmortem sample of Thai men. Since brain mass-body size relations may be influenced by age, the hypothesis was secondarily explored in Thai men age < or =45 yr (n = 299) and with brain magnetic resonance imaging (MRI) studies in Korean men (n = 30) age > or =20<30 yr. The scaling of large body compartments was examined in a third group of Asian men living in New York (NY, n = 28) with MRI and dual-energy X-ray absorptiometry. Brain mass scaled to height with a power (mean +/- SEE; 0.46 +/- 0.13) significantly smaller (P < 0.001) than that of BW scaled to height (2.36 +/- 0.19) in the whole group of Thai men; brain mass/BW scaled negatively to height (-1.94 +/- 0.20, P < 0.001). Similar results were observed in younger Thai men, and results for brain mass/BW vs. height were directionally the same (P = 0.09) in Korean men. Skeletal muscle and bone scaled to height with powers similar to that of BW (i.e., approximately 2-3) in the NY Asian men. Models developed using REE estimates in Thai men suggest that brain accounts for most of the REE/BW height dependency. Tall and short men thus differ in relative brain mass, but the proportions of BW as large compartments appear independent of height, observations that provide a potential mechanistic basis for related differences in REE and that have implications for the study of adult energy requirements.

The Effect of Egg Consumption in Hyperlipidemic Subjects during Treatment with Lipid-Lowering Drugs

Background. Limiting egg consumption to avoid high cholesterolemia is recommended to reduce risk of cardiovascular disease. However, recent evidences suggest that cholesterol from diet has limited influence on serum cholesterol. Objective. To assess the effect of egg consumption on lipid profiles in hyperlipidemic adults treated with lipid-lowering drugs. Material and Method. Sixty hyperlipidemic subjects, mean age of 61 years, who had been treated with lipid-lowering drugs. Every subject was assigned to consume additional 3 eggs per day with their regular diet for 12 weeks. Measurements for lipid profiles and body compositions were performed. Results. An additional consumption of 3 eggs per day for 12 weeks increased HDL-cholesterol by 2.46 ± 6.81 mg/dL (P < 0.01) and decreased LDL-cholesterol to HDL-cholesterol ratio by 0.13 ± 0.46 (P < 0.05). No significant changes were found in other lipid profiles. Body weight and body mass index were significantly increased at 12th week by 0.52 ± 1.83 kg and 0.31 ± 0.99 kg/m2, respectively (P < 0.05). Conclusion. In hyperlipidemic adults who were treated with lipid-lowering drugs, the consumption of additional 3 eggs per day to their regular diet will increase the level of HDL-cholesterol and decrease the ratio of LDL-cholesterol to HDL-cholesterol.

Nutritional Status Assessment in Cirrhotic Patients after Protein Supplementation

Background. Protein supplementation has been shown to be effective for the treatment of malnourished patients with liver cirrhosis. The parameters used to assess nutritional improvement in cirrhotic patients for such treatment are important. Objective. To evaluate the parameters for assessment of nutritional status in patients with liver cirrhosis after protein supplementation. Material and Method. A cross-sectional, prospective clinical trial with 22 cirrhotic patients was performed. Data from anthropometry, bioelectrical impedance, subjective global assessment (SGA), and visceral protein were gathered and analyzed to assess nutritional improvement after protein supplementation. Results. Twenty-two cirrhotic patients (mean age 52.9 ± 12.8 years; 54.5% male; 63.6% alcoholic cirrhosis; 63.6% Child-Pugh C) were recruited. After protein supplementation, a significant improvement was demonstrated in the SGA class A from 10 patients (45.5%) to 16 (72.7%) and 18 (81.8%) at the 4th and 8th weeks, respectively. Body weight, body mass index, and lean muscle mass were significantly increased from baseline at the 8th week. No significant change in other nutritional parameters was observed. Conclusions. The SGA and lean muscle mass were significant parameters in order to assess nutritional status in cirrhotic patients after protein supplementation.

The Effect of Tinospora crispa on Serum Glucose and Insulin Levels in Patients with Type 2 Diabetes Mellitus

Objective. To determine the effects of Tinospora crispa on serum glucose and insulin levels in healthy subjects and patients with type 2 diabetes mellitus. Method. Serum from 10 healthy subjects and 10 diabetic participants, who had fasted overnight, were obtained every 30–60 minutes during the 3 hours of continued fasting and during the 3 hours after ingestion of 75 g of glucose with or without ingestion of 125 or 250 g of Tinospora crispa dry powder capsule. Glucose and Insulin levels were analyzed and the areas under the curve for mean serum glucose and insulin levels were calculated. Result. The areas under the curve of mean serum glucose and insulin levels in both healthy and diabetic participants were not significantly different between with or without Tinospora crispa dry powder capsule. In diabetic participants the area under the curve of glucose was slightly lesser when 250 mg of Tinospora crispa was ingested, but not reaching statistical significance (478 and 444 mg min/ml, resp., P = 0.57). Conclusion. The results suggest that Tinospora crispa ingestion cannot affect serum glucose and insulin levels in healthy subjects or patients with type 2 diabetes mellitus.

Continuous Nasoenteral Feeding: Inverse Relation Between Infusion Rate and Serum Levels of Bilirubin

The relation between nasoenteric formula caloric infusion rate and the serum bilirubin level was examined in 15 healthy subjects. The study protocol spanned 3 days and included fasting studies on day 1, continuous maintenance nasogastric feeding of a formula diet on day 2, and continuous feeding at a rate twice the maintenance level on day 3. Blood studies were performed in the early morning of each day. Fifteen subjects underwent the fasting measurements and the maintenance infusion, while 11 underwent all 3 days of the protocol. With the maintenance infusion serum bilirubin fell from the fasting value of (X +/- SD) 0.77 +/- 0.53 to 0.63 +/- 0.49 mg/dl for a reduction of 18% (p less than 0.05). For the subgroup of 11 subjects receiving two levels of formula infusion, fasting and maintenance serum bilirubin levels were 0.81 +/- 0.57 and 0.65 +/- 0.47 mg/dl, respectively, (p less than 0.05). With the twice maintenance infusion the plasma bilirubin decreased further to 0.46 +/- 0.29 mg/dl, a decrement of 43% relative to fasting (p less than 0.01). No other significant changes were detected during the protocol in the standard blood chemical and hematologic studies. Thus, the serum level of bilirubin is inversely related to the formula caloric infusion rate during continuous nasoenteric feeding.

Effect of daily egg ingestion with thai food on serum lipids in hyperlipidemic adults.

Thai food is one of the healthiest foods. In fact, several Thai dishes, such as Tom Yum soup, are currently under scientific study for their incredible health benefits. Limited data are available on the effects of egg consumption with Thai food in hyperlipidemic patients. To assess the effects of daily egg consumption with Thai food, which is known as low fat diet, on serum lipids profiles in hyperlipidemic subjects without medication treatment, the randomized crossover trial of 71 hyperlipidemic adults (8 men, 63 women) were randomly to one of the two sequences of one and three eggs/day for 4 weeks. Each treatment was separated by a four-week washout period (egg-free). Our data indicated that one or three eggs/day consumption were significantly increases total serum cholesterol (221.54 ± 42.54 and 225.31 ± 45.06 versus 211.57 ± 39.98 mg/dL) and LDL-C levels (141.38 ± 38.23 and 145.48 ± 39.33 versus 133.44 ± 34.52 mg/dL) as compared to egg-free period. No significant change of serum TG, HDL-C, TC/HDL-C, and LDL-C/HDL-C levels was observed after 1 or 3 eggs consumption daily in this study.