A6. Appetite and nutritional intake in patients with chronic liver disease
Authors: McCollum K. 
Published: March 2003

Background Undernutrition is common in patients with chronic liver disease (CLD), mainly due to a decrease in energy intake (
Neilsen, K et al., 1993
). However the anorexia of CLD remains poorly understood.

Aim To examine parameters of appetite and nutritional intake in a group of stable CLD patients in comparison with healthy subjects.

Methods Seven patients admitted for assessment for orthotopic liver transplant were recruited. A group of five healthy subjects were also recruited for comparable analysis.

Severity of the disease was assessed using Child’s Pugh Classification ( Pugh et al., 1973
) Nutritional status was estimated from BMI and arm anthropometry. Appetite, hunger and satiety ratings were determined using visual analogues scales (VAS). All subjects were asked to complete VAS for satiety, appetite, hunger and satiation before eating, on cessation of eating, 1 h and 2 h after eating at Breakfast, Lunch and Evening Meal. On the day of the study, a weighed intake and analysis (COMP‐EAT 4, Nutrition Systems, London) was performed. Data were analysed using the SPSS package. Paired student t‐tests were using in comparative analysis and Pearson’s Correlation to assess the strength of linear relationships between variables.

Results No difference in BMI and weight was found between CLD patients and controls, however, tricep skinfold thickness was significantly lower in CLD patients when compared with the control group (83.5 ± 8 mm vs. 108 ± 5 mm, P < 0.05).

Before and immediately following an eating episode there was no difference in VAS for appetitie between the CLD patients and healthy subjects. Post prandially, appetite parameters in the CLD patients remained suppressed for longer. One hour after eating there was a significant difference between appetite parameters (17.6 ± 5 mm vs. 49.6 ± 5 mm, P < 0.05) and this continued for at least 2 h after eating (21.7 ± 9 mm vs. 68.5 ± 2 mm, P < 0.05) which was at the end of this study period.

Mean energy intake was significantly lower in the CLD patients. (2657 ± 263 kcal 1698 ± 347 kcal, P < 0.05). When their energy intake was compared with the recommended energy requirements (Schofield, 1985) it was found that only one CLD patient met their requirements.

It is possible that the severity of disease affected the nutritional status and appetite variables. However in this study no relationship was found between nutritional intake or nutritional status when compared with disease severity but a strong association was demonstrated between liver disease and appetite measures. (P < 0.004)

Conclusions This study suggests that before an eating episode control subjects and CLD patients rating of hunger are comparable. However in CLD for the early and late post prandial period, appetite remains suppressed and satiation elevated when compared with healthy controls. These findings have important implications for dietetic practice. Traditionally high density supplements are offered to CLD patients after a meal but this study suggests a more appropriate time for energy supplementation is before a meal.