Effect of a late evening meal on nitrogen balance in patients with cirrhosis of the liver

OBJECTIVE--To assess whether a late evening meal would improve nitrogen balance in patients with cirrhosis of the liver. DESIGN--Randomised crossover study of meal schedules comparing three meals a day with four or six meals a day, the four and six meal schedules both including a late evening meal (...

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Bibliographic Details
Published in:BMJ 1989-11, Vol.299 (6709), p.1202-1203
Main Authors: Swart, G. R., Zillikens, M. C., van Vuure, J. K., van den Berg, J. W.
Format: Article
Language:English
Subjects:
Adult
Aged
Alcohols
Amino acids
balance studies
Cirrhosis
Diet
dinner
Eating - physiology
Female
Humans
Liver Cirrhosis - metabolism
Male
men
Middle Aged
Nitrogen
Nitrogen - administration & dosage
Nitrogen - metabolism
Nitrogen balance
Nutritional Status
Physicians
Protein requirement
Random Allocation
Time Factors
women
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Summary:OBJECTIVE--To assess whether a late evening meal would improve nitrogen balance in patients with cirrhosis of the liver. DESIGN--Randomised crossover study of meal schedules comparing three meals a day with four or six meals a day, the four and six meal schedules both including a late evening meal (2300). SETTING--Metabolic ward. PATIENTS--Seven men and two women aged 34-66 with cirrhosis of the liver (Child's grade B). INTERVENTIONS--Patients spent two seven day periods in the ward. For five days of each period they received, in random order, isonitrogenous isocaloric diets supplied in three meals a day and in four or six meals a day. MAIN OUTCOME MEASURE--Nitrogen balance, calculated as the difference between dietary intake and the total of urinary, faecal, and integumental nitrogen loss. RESULTS--Faecal nitrogen loss was no different between three meals a day and four or six meals a day. On both four and six meals a day, however, patients had nitrogen balances that were more positive (or less negative) than on three meals a day (1.26 (SD 2.1) g/24 h v 0.26 (2.2) g/24 h, p less than 0.01). Six meals a day did not produce significantly better improvements in nitrogen balance than four meals a day. CONCLUSIONS--A late evening meal seemed to improve the efficiency of nitrogen metabolism, but longer term studies are needed to assess whether this leads to a better nutritional state.
ISSN:0959-8138
0267-0623
1468-5833
1756-1833
DOI:10.1136/bmj.299.6709.1202