Total and individual free fatty acid concentrations in liver cirrhosis

doi:10.1016/0026-0495(84)90064-7

Metabolism

Volume 33, Issue 7, July 1984, Pages 646-651

https://doi.org/10.1016/0026-0495(84)90064-7 Get rights and content

Abstract

The finding of high plasma free fatty acid (FFA) levels in cirrhotic patients has been attributed either to decreased hepatic clearance or to enhanced fat mobilization. To better clarify these hypotheses, total and individual FFA and glycerol levels were determined in 21 cirrhotic patients with different degrees of hepatocellular damage (evaluated by liver function tests), portal hypertension (evaluated by endoscopy and clinical signes), and nutritional status (evaluated by anthropometric and biohumoral parameters) and in 10 age- and sex-matched healthy subjects. Glucose tolerance and insulin and glucagon levels were determined in all individuals. Well-nourished and malnourished patients were identified within the cirrhotic group. Plasma FFA and glycerol concentrations were well correlated (r = 0.47, P < 0.05), levels being significantly higher in cirrhotic individuals than in controls (746.6 ± 46.29 SE v 359.22 ± 40.82 μmol/L, P < 0.001 for plasma FFA; 150.1 ± 3.12 v 82.5 ± 9.2 μmol/L, P < 0.01) for glycerol). Plasma FFA and glycerol showed no correlation with the liver function test results or portal hypertension parameters. Interestingly, plasma levels of FFA and glycerol were influenced by the nutritional status, significantly higher FFA levels being observed in the well-nourished than in the malnourished patients (842.5 ± 47.5 v 563.4 ± 78 μmol/L, P < 0.005). Furthermore, a positive correlation was found between plasma glycerol level and percentage of triceps skinfold (r = 0.45, P < 0.05). No correlation was found between plasma levels of FFA or glycerol and glucose tolerance, insulin and glucagon. So far the individual FFA patterns are concerned, a significant percentage decrease was observed in palmitic and stearic acid levels and a significant percentage increase in palmitoleic and oleic acid levels in the cirrhotic group, no difference being found between well-nourished and malnourished patients. In conclusion, the high plasma FFA and glycerol levels in patients with liver cirrhosis do not appear to depend on the degree of liver damage or portal hypertension, but rather are due to enhanced lipolysis. Fat mobilization appears to decrease as malnutrition advances.

References (24)

O Riggio et al.
Glucose intolerance in liver cirrhosis
Metabolism
(1982)
D Sampson et al.
A rapid gas chromatographic method for the quantitation of underivatised individual free fatty acids in plasma
Clin Chim Acta
(1975)
P Bjorntorp et al.
Lipid mobilization in relation to body composition in man
Metabolism
(1969)
MS Harewood et al.
Insulin action and cirrhosis: Insulin binding and lipogenesis in isolated adipocytes
Metabolism
(1982)
PJ Randle et al.
The glucose fatty acid cycle
Lancet
(1963)
D Berkowitz
Glucose tolerance, free fatty acid, and serum insulin responses in patients with cirrhosis
Am J Dig Dis
(1969)
O Gunnlaugsson et al.
Individual free fatty acids in patients with liver disease
Am J Dig Dis
(1977)
A Mortiaux et al.
Plasma free fatty acid in liver disease
Gut
(1961)
RM Alexander et al.
Correlation of clinical severity and abnormality in triglyceride metabolism
Metabolism
(1963)
JE Fischer
Current status and pathogenesis of hepatic coma. Aminoacidi ed encefalopatia epatica

R Sherwin et al.

Hyperglucagonemia in Laennec's cirrhosis

N Engl J Med

(1974)

H Ring-Larsen et al.

Sympathetic nervous activity and renal and systemic hemodynamics in cirrhosis: Plasma norepinephrine concentration, hepatic extraction and renal release

Hepatology

(1982)

Cited by (45)

Chapter 26 - Preoperative and postoperative nutrition in hepatobiliary surgery
2017, Blumgart's Surgery of the Liver, Biliary Tract and Pancreas: Sixth Edition
Recovery of nutritional metabolism after liver transplantation
2015, Nutrition
Citation Excerpt :
This is due to the increased rate of lipolysis in fat tissue [11]. It has been suggested that this increase in lipolysis may be a useful predictor of npRQ [10–12]. Some studies reported that LTx may effectively reverse cirrhosis-induced alterations in glucose metabolism [13,14].
Perioperative nutritional assessment is critically important to reflect nutritional management because liver transplantation (LTx) often is undertaken in patients with poor nutritional status. The aim of this study was to evaluate nutritional status, including the non-protein respiratory quotient (npRQ), resting energy expenditure (REE), nitrogen balance, and blood biochemical parameters in patients before and after LTx.
Fourteen patients undergoing LTx and 10 healthy controls were enrolled in this study. The npRQ and REE were measured using indirect calorimetry before LTx and at 2, 3, and 4 wk after the procedure. Blood biochemistry and nitrogen balance calculated by 24-h urine collection were performed concurrently with indirect calorimetric measurement; the results were compared between the two groups.
Before LTx, npRQ was significantly lower and serum non-esterified fatty acid levels were significantly higher in the patients than in the controls. Furthermore, a negative nitrogen balance was observed in the patients. These, however, improved significantly at 4 wk after LTx. REE did not significantly increase compared with the preoperative values in recipients. Blood biochemistry showed gradually increasing levels of serum cholinesterase and albumin. These failed to reach to normal levels by 4 wk post-transplant.
The findings revealed that improvement of nutritional metabolism after LTx may require 4 wk. Additional nutritional strategies, therefore, may be needed to minimize catabolic state during the early post-transplant period. Adequate, individualized nutritional guidance before and after LTx should be performed in these patients.
Recovery pattern of non-protein respiratory quotient and non-esterified fatty acids after liver resection
2014, Nutrition
Citation Excerpt :
Several studies showed that NEFA levels are higher in patients with cirrhosis than normal individuals after overnight fasting and closely correlated with severity [7,25,26]. High NEFA levels were caused by an increased rate of lipolysis in the fat tissue in the fasting state [25]. Moreover, it is reported that NEFA levels may be useful predictor of npRQ and useful to determine the indication and effectiveness of LES therapy in cirrhotic patients [26,27].
Perioperative nutritional care is important to maintain preoperative and postoperative nutritional status. However, few reports have investigated energy metabolism after hepatectomy. The aim of this study was to determine differences in energy metabolism, blood biochemistry, and nutritional status before and after liver resection in patients with hepatocellular carcinoma (HCC) and healthy living donors for liver transplantation.
Eighteen hospitalized patients with HCC group and 13 living donors for liver transplantation (donor group) were enrolled in this study. The donor group was divided into two groups on the basis of age; Y-donor group (age < 40 y, n = 7), and O-donor group (age ≥ 40 y, n = 6). Energy metabolism was measured by indirect calorimetry at preoperative day and postoperative day (POD) 7 and 14, and blood biochemistry was also examined.
Recovery of non-protein respiratory quotient (npRQ) and blood biochemical data such as total bilirubin, aspartate aminotransferase and alanine aminotransferase levels were observed in Y-donor group on POD 14. However, although biochemical data improved in the HCC and O-donor group, npRQ remained unchanged on POD 14.
Improvement of npRQ took longer than blood biochemical data in patients with HCC and older donors. Because the recovery of npRQ is associated with donor age, careful nutritional management may be required for a longer time depending on the pathophysiological condition of each patient after hepatectomy.
Preoperative and postoperative nutrition in hepatobiliary surgery
2012, Blumgart's Surgery of the Liver, Biliary Tract and Pancreas
Preoperative and Postoperative Nutrition in Hepatobiliary Surgery
2006, Surgery of the Liver, Biliary Tract and Pancreas: Volumes 1-2, Fourth Edition
Absorption and transport of dietary long-chain fatty acids in cirrhosis: A stable-isotope-tracing study
2005, American Journal of Clinical Nutrition
Background: In rats, 30–70% of dietary fatty acids (FAs) are absorbed through the portal vein. Whether this occurs in humans is unknown, but it may occur in persons with cirrhosis, who show a blunted chylomicronemic response to dietary fat without significant steatorrhea.
Objective: The objective was to investigate whether portal FA absorption occurs in humans with cirrhosis.
Design: Six control subjects and 10 patients with ( n = 5) and without ( n = 5) cirrhotic ascites were fed [1-¹³C]palmitic and oleic acids in a test meal. Samples were drawn before and 30, 60, 90, 120, 240, 360, 480, and 720 min afterward for plasma [1-¹³C]-labeled FAs and breath ¹³CO₂ assay. Fecal [1-¹³C]-labeled FAs were also measured.
Results: [1-¹³C]-Labeled FAs increased in chylomicrons in all groups, but less in ascitic cirrhotic patients, because their median area under the curve from 120 to 720 min was significantly lower than in the control subjects for labeled palmitate [520 (interquartile range: 192–1137) compared with 2862 (2674–4175) μmol · min/L] and oleate [829 (781–1263) compared with 3119 (2939–4986) μmol · min/L]. [1-¹³C]-Labeled FA enrichment of VLDL was also lower in cirrhotic patients. [1-¹³C]-Labeled FA in free FAs peaked earlier in ascitic than in nonascitic patients and control subjects, mainly for [1-¹³C]oleate, and the median area under the curve from 0 to 120 min was significantly higher in ascitic patients than in control subjects [301 (255–400) compared with 48 (34–185) μmol · min/L]. Fecal excretion of [1-¹³C]-labeled FA was negligible and not significantly different between groups.
Conclusions: The low [1-¹³C]-labeled FA concentrations in chylomicrons and VLDL, without increased fecal losses, confirm previous data in cirrhotic patients with the use of an unlabeled fat load. The earlier [1-¹³C]-labeled FA appearance in free FAs supports the portal absorption of dietary fat in patients with advanced cirrhosis with spontaneous portal-systemic shunting.

View all citing articles on Scopus

^☆: Supported in part by Grant 8100025.04 C.N.R.

View full text

Total and individual free fatty acid concentrations in liver cirrhosis☆

Abstract

Metabolism

Clin Chim Acta

Metabolism

Metabolism

Lancet

Glucose tolerance, free fatty acid, and serum insulin responses in patients with cirrhosis

Am J Dig Dis

Individual free fatty acids in patients with liver disease

Am J Dig Dis

Plasma free fatty acid in liver disease

Gut

Correlation of clinical severity and abnormality in triglyceride metabolism

Metabolism

Current status and pathogenesis of hepatic coma. Aminoacidi ed encefalopatia epatica

Hyperglucagonemia in Laennec's cirrhosis

N Engl J Med

Sympathetic nervous activity and renal and systemic hemodynamics in cirrhosis: Plasma norepinephrine concentration, hepatic extraction and renal release

Hepatology