Energy Expenditure and Liver Transplantation: What We Know and Where We Are

Abstract

Patients with end‐stage liver disease (ESLD) and undergoing liver transplantation (LTx) commonly present with malnutrition attributed to various etiologies. One of the causes is potential hypermetabolism resulting from increased resting energy expenditure (REE). After the surgery, it is hypothesized that these patients show a reduction in REE, which may contribute to the weight gain observed in this population. However, there have been controversial results regarding the metabolic status of ESLD patients and liver recipients, which has led us to critically review the pertinent literature. We enrolled studies with the following goals: assessment of REE of these patients either before or after surgery by using indirect calorimetry (measured REE [mREE]) and comparison of these mREE values with those of healthy controls or with REE values obtained using predictive equations (predicted REE [pREE]). For most patients, mREE and pREE values were comparable. However, ≥5.3% of patients exhibited hypermetabolism when the mREE was compared with the pREE using the Harris‐Benedict formula. Three follow‐up studies that were conducted postsurgery showed a progressive reduction in the mREE for ≤1 year. However, conflicting data have been published, and cross‐sectional studies have not reported hypometabolic patients. In conclusion, there is no consensus regarding the metabolic status of pre‐LTx and post‐LTx patients, which may be due to differences in the methods used for comparison. Therefore, we highlight this aspect of LTx patient management, which impacts the quality of nutrition therapy required by these patients.

Novel clinical algorithm for hypothalamic obesity in youth with brain tumours and factors associated with excess weight gain

“…More specifically, central hypothyroidism and precocious puberty were significantly associated with elevated recent BMI category ( p = 0.017 and p = 0.002, respectively), while other hypothalamic–pituitary abnormalities, including growth hormone deficiency, central adrenal insufficiency, diabetes insipidus, and hypogonadotropic hypogonadism, were not. Twenty individuals in this analysis underwent IC, with 17 (85%) showing hypometabolism (defined as measured resting energy expenditure <80% of predicted basal metabolic rate 18 using the Schofield predictive equation) 19 . Of those with hypometabolism, 13 had obesity, two overweight, and two normal weight (BMIz 0.8 and − 0.17) at recent BMI.…”

The Role of Indirect Calorimetry in Care of the Surgical Patient

“…One plausible explanation is that hypermetabolism results from increased REE which then decreases after liver transplantation. There is no consensus regarding the metabolic state pre-liver transplant and post-liver transplant and therefore IC is a helpful and essential tool in high-quality nutrition management [ 30 ].…”