Provided by Healio
June 24, 2013
Patients treated for hepatocellular carcinoma who had a lower dietary fat intake experienced slower recovery from invasive therapies in a recent study.
Researchers assessed the dietary intake of 35 patients with hepatocellular carcinoma (HCC) before and after hospitalization. Nitrogen balance and nonprotein respiratory quotient (npRQ) were measured upon admission and four days later.
Patients’ mean dietary intake at admission was 1,977 ± 513 kcal/day, with a negative nitrogen balance (–2.1 ± 4.5 g/dL) and an npRQ of 0.83 ± 0.061. While at the hospital, mean intake was 1,834 ± 290 kcal/day (P=.061 for difference), with a similar nitrogen balance (–3.0 ± 2.8 g/dL; P=.31). The npRQ after 4 days in-hospital was 0.86 ± 0.075 (P=.0032).
Five patients experienced minimal hepatic encephalopathy (MHE), and investigators observed a trend toward lower npRQ among them compared with patients without MHE (0.78 ± 0.027 vs. 0.84 ± 0.062; P=.082). The MHE patients received significantly lower amounts of fat energy than those without MHE (18.9% ± 3.8% vs. 23.6% ± 4.2%; P=.024) and energy from fat intake trended positively with npRQ values (P=.11; r=0.28). A correlation was observed between change to npRQ after hospitalization and the difference between energy from fat intake through at-home and in-hospital diets (P=.014; r=.41).
In a further analysis of 20 cases, recovery speed after invasive HCC therapy as indicated by reduction rate of prothrombin time (PT) was negatively correlated with the post-admission change to npRQ (P=.0002; r=–0.73). Patient hospital stay after reaching peak PT-international normalized ratio was longer among five cases with low npRQ after admission compared with those who experienced npRQ improvement in-hospital (175 ± 76 days vs. 40 ± 59 days; P=.0006).
“These findings strongly suggest that nutritional intervention, especially for fat intake, should be involved in the HCC treatment scheme both at home and in the hospital,” the researchers concluded. “Because a hypermetabolic state and inappropriate nutritional usage may hamper the calculation of an exact energy requirement in cirrhotic patients, nutritional supports should be conducted based on a nutritional assessment, which includes nitrogen balance, npRQ and MHE.”