NatureandQuantity ofFuelsConsumedin Patients withAlcoholic Cirrhosis

Although alcoholism isaleading cause ofmorbidity andmortality ofmiddle-aged Americans, there arenodataavailable pertaining totheconse- quences ofLaennec's cirrhosis ontotal bodyenergy requirements ormechanisms formaintaining fuel ho- meostasis inthis patient population. Therefore, wesi- multaneously usedthetechniques ofindirect calorim- etryandtracer analyses of("4C)palmitate tomeasure thenature andquantity offuels oxidized bypatients withbiopsy-proven alcoholic cirrhosis andcompared theresults withvalues obtained fromhealthy volun- teers. Cirrhotic patients werestudied after anover- night fast (10-12 h).Normalvolunteers werestudied after anovernight fast (12h)orafter alonger period ofstarvation (36-72 h). Total basal metabolic requirements weresimilar in overnight fasted cirrhotic patients (1.05±0.06 kcal/ minper1.73m2),overnight fasted normal subjects (1.00±0.05 kcal/min per1.73 m2), and36-72-h fasted normal volunteers (1.10±0.06 kcal/min per1.73m2). Indirect calorimetry revealed thatincirrhotic pa- tients thepercentages oftotal calories derived from fat(69±3%), carbohydrate (13±2%), andprotein (17±4%) werecomparable tothose foundin36-72-h fasted subjects, butwereclearly different fromthose ofovernight fasted normal individuals whoderived 40±6,39±4,and21±2%fromfat, carbohydrate, and protein, respectively. Thesedataarestrikingly similar todataobtained through tracer analyses of('4C)palmitate, which showed thatinovernight fasted patients withalcoholic cir- Thisworkwaspresented inpartattheAnnualmeeting oftheAmericanGastrointestinal Association, May1978, Las Vegas, NE. Address reprint requests toDr.Owen. Received forpublication 18March1983andinrevised formIJuly1983.