Whole-body protein turnover and energy expenditure in post-viral hepatocirrhotic patients. A study using multiple stable isotope tracers to estimate protein and energy requirements and the efficacy of a new diet therapy based on Chinese food

L-[1-13C]-leucine and 15N-glycine doubly-labelled tracer experiments revealed accelerated kinetics of leucine, glycine and whole-body protein in post-viral hepatocirrhotic patients. Together with the results of nitrogen balance measurement, the daily protein requirement of these patients was estimated to be higher than 1.2 g/kg/d. Doubly labelled water experiments and NaH13CO3 experiments revealed that the freely living and basal energy expenditure of post-viral hepatocirrhotic patients was not different from that in normal subjects with comparable physical and mental activities. For those freely living in hospital, the energy requirements is estimated to be 150-160 kJ/kg/d. According to the above results, a therapeutic diet formulation based on Chinese food was designed for the patients which contained 1.5 g/kg/d of protein and 150-160 kJ/kg/d. 60-70% of the dietary protein was of vegetable origin, with a branched chain amino acid/aromatic amino acid ratio slightly but significantly higher than the common hospital diet. Patients with compensated post-viral hepatocirrhosis adapted to the diet rapidly. After two months' therapy, the negative nitrogen balance turned positive along with an increase of body weight and urinary creatinine, indicating and improvement of general nutritional status, probably with accumulation of muscle protein. The diet is relatively cheap, can be easily handled by the patients themselves, and hence is also applicable to outpatients. 54 refs, 8 tabs