Protein-Energy Malnutrition in Patients with Liver Cirrhosis

Protein-energy malnutrition (PEM) is frequently seen in patients with liver cirrhosis. This condition is associated with a poorprognosis and reduced survival. We investigated the protein and energy metabolic status, including serum albumin concentration,and resting energy expenditure (REE) and respiratory quotient (RQ) measured by indirect calorimetry in 23 patients withliver cirrhosis (8 men and 15 women; mean age, 60.3 years). The median value of %REE (measured REE / predicted REE)was highest in Child-Pugh grade A and lowest in grade C, and the range of RQ tended to be highest in Child-Pugh grade Aand lowest in grade C, although there were not statistically significant (p=0.871 and 0.664, respectively). Serum triglycerideconcentration was significantly lower in patients who had an RQ less than 0.85 than in patients who had an RQ of 0.85 ormore, and free fatty acid tended to be higher in patients who had an RQ less than 0.85 than in patients who had an RQ of 0.85or more. Of the 23 patients, 78.3% were in a state of protein and/or energy malnutrition and 47.8% had PEM. Our results suggestthat %REE and RQ were not significantly associated with liver function, but the oxidation rate of fat was increased in advancedliver cirrhosis. A longitudinal study in a large population is needed to determine the efficacy of %REE and RQ measurementsfor adequate nutritional treatment and improvement of patient outcome

The Relationship between Energy Expenditure and Type or Stage of Cancer

Malnutrition commonly occurs in patients with cancer. This situation can be associated with increased morbidity and mortality.The etiology is not clearly understood but decreased energy intake and increased energy expenditure may be involved. Weaimed to investigate the energy metabolic status including energy expenditure in patients with various cancers. The clinicalfeatures and energy metabolic status measured by indirect calorimetry of 74 patients with cancer (50 men and 24 women;mean age, 64.7 years) were obtained from the medical records. Hypermetabolism was more common and REE/kg (resting energyexpenditure / kg body weight) seems to be more reliable in estimating the true energy expenditure than %REE (measuredREE / predicted REE). The REE/kg and VO2 /kg (oxygen consumption per minute / kg body weight) varied among cancertypes, i.e., they were significantly higher in gastric cancer than in hepatocellular carcinoma. Moreover, REE/kg and VO2/kg wassignificantly higher in cancer stage IV than in stage I, or stages I and II. Patients with or at risk for malnutrition should receiveappropriate nutritional support, which has to be personalized according to tumor site, tumor stage, and the nutritional statusof the patient. This nutritional support should improve not only the patients\u27 quality of life but also their survival

Initial Surgical Versus Conservative Strategies in Patients With Asymptomatic Severe Aortic Stenosis

AbstractBackgroundCurrent guidelines generally recommend watchful waiting until symptoms emerge for aortic valve replacement (AVR) in asymptomatic patients with severe aortic stenosis (AS).ObjectivesThe study sought to compare the long-term outcomes of initial AVR versus conservative strategies following the diagnosis of asymptomatic severe AS.MethodsWe used data from a large multicenter registry enrolling 3,815 consecutive patients with severe AS (peak aortic jet velocity >4.0 m/s, or mean aortic pressure gradient >40 mm Hg, or aortic valve area <1.0 cm2) between January 2003 and December 2011. Among 1,808 asymptomatic patients, the initial AVR and conservative strategies were chosen in 291 patients, and 1,517 patients, respectively. Median follow-up was 1,361 days with 90% follow-up rate at 2 years. The propensity score–matched cohort of 582 patients (n = 291 in each group) was developed as the main analysis set for the current report.ResultsBaseline characteristics of the propensity score–matched cohort were largely comparable, except for the slightly younger age and the greater AS severity in the initial AVR group. In the conservative group, AVR was performed in 41% of patients during follow-up. The cumulative 5-year incidences of all-cause death and heart failure hospitalization were significantly lower in the initial AVR group than in the conservative group (15.4% vs. 26.4%, p = 0.009; 3.8% vs. 19.9%, p < 0.001, respectively).ConclusionsThe long-term outcome of asymptomatic patients with severe AS was dismal when managed conservatively in this real-world analysis and might be substantially improved by an initial AVR strategy. (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis Registry; UMIN000012140

Decline in Left Ventricular Ejection Fraction during Follow-up in Patients with Severe Aortic Stenosis

Objectives: The aim of this study was to investigate the prognostic impact of the decline in left ventricular ejection fraction (LVEF) at 1-year follow-up in patients with severe aortic stenosis (AS) managed conservatively. Background: No previous study has explored the association between LVEF decline during follow-up and clinical outcomes in patients with severe AS. Methods: Among 3, 815 patients with severe AS enrolled in the multicenter CURRENT AS (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis) registry in Japan, 839 conservatively managed patients who underwent echocardiography at 1-year follow-up were analyzed. The primary outcome measure was a composite of AS-related deaths and hospitalization for heart failure. Results: There were 91 patients (10.8%) with >10% declines in LVEF and 748 patients (89.2%) without declines. Left ventricular dimensions and the prevalence of valve regurgitation and atrial fibrillation or flutter significantly increased in the group with declines in LVEF. The cumulative 3-year incidence of the primary outcome measure was significantly higher in the group with declines in LVEF than in the group with no decline (39.5% vs. 26.5%; p 10% declines in LVEF at 1 year after diagnosis had worse AS-related clinical outcomes than those without declines in LVEF under conservative management. (Contemporary Outcomes After Surgery and Medical Treatment in Patients With Severe Aortic Stenosis Registry; UMIN000012140

The Effect of Olive Leaf Extract on Hepatic Fat Accumulation in Sprague-Dawley Rats Fed a High-fat Diet

Oleuropein, the active constituent of olive leaf extract, possesses anti-oxidant, hypoglycemic, and hypolipidemic activities. We aimed to assess whether the effect of olive leaf extract on hepatic fat accumulation is preventive or therapeutic. Sprague-Dawley (SD) rats were fed a high-fat diet with (ODOD group) or without (HDHD group) olive leaf extract (1,000 mg/kg diet) for 38 weeks. Another group of rats were fed a high-fat diet for 23 weeks, followed by a high-fat diet with olive leaf extract (1,000 mg/kg diet) for 15 weeks (HDOD group). Serology, histopathology, anti-oxidative activity, and liver fatty acid synthesis were compared to those fed a standard diet (LDLD group) at 26 and 41 weeks of age. The serum levels of total cholesterol, triglyceride and aspartate aminotransferase tended to be lower in the ODOD group as compared to the HDHD and HDOD groups, although there were no significant differences. Histopathologically, hepatic steatosis tended to be less evident in the HDOD and ODOD groups as compared to the HDHD group, and lobular inflammation was not observed in the ODOD group at 26 weeks of age. Hepatic thioredoxin-1 staining tended to be less evident in the ODOD group than in the HDHD and HDOD groups at 41 weeks of age. There were no significant differences in hepatic lipogenic enzyme activities between the ODOD group and HDHD/HDOD groups. Our data suggest that olive leaf extract had a preventive, rather than therapeutic, effect on hepatic steatohepatitis in SD rats fed a high-fat diet

Stent-Related Adverse Events as Related to Dual Antiplatelet Therapy in First- vs Second-Generation Drug-Eluting Stents

[Background] There are limited data on the long-term stent-related adverse events as related to the duration of dual antiplatelet therapy (DAPT) in second-generation (G2) drug-eluting stents (DES) compared with first-generation (G1) DES. [Objectives] This study sought to compare the long-term stent-related outcomes of G2-DES with those of G1-DES. [Methods] The study group consisted of 15, 009 patients who underwent their first coronary revascularization with DES from the CREDO-Kyoto PCI/CABG (Coronary Revascularization Demonstrating Outcome Study in Kyoto Percutaneous Coronary Intervention/Coronary Artery Bypass Grafting) Registry Cohort-2 (first-generation drug-eluting stent [G1-DES] period; n = 5, 382) and Cohort-3 (second-generation drug eluting stent [G2-DES] period; n = 9, 627). The primary outcome measures were definite stent thrombosis (ST) and target vessel revascularization (TVR). [Results] The cumulative 5-year incidences of definite ST and TVR were significantly lower in the G2-DES group than in the G1-DES group (0.7% vs 1.4%; P < 0.001; and 16.2% vs 22.1%; P < 0.001, respectively). The lower adjusted risk of G2-DES relative to G1-DES for definite ST and TVR remained significant (HR: 0.53; 95% CI: 0.37-0.76; P < 0.001; and HR: 0.74; 95% CI: 0.68-0.81; P < 0.001, respectively). In the landmark analysis that was based on the DAPT status at 1 year, the lower adjusted risk of on-DAPT status relative to off-DAPT was significant for definite ST beyond 1 year in the G1-DES stratum (HR: 0.42; 95% CI: 0.24-0.76; P = 0.004) but not in the G2-DES stratum (HR: 0.66; 95% CI: 0.26-1.68; P = 0.38) (Pinteraction = 0.14). [Conclusions] G2-DES compared with G1-DES were associated with a significantly lower risk for stent-related adverse events, including definite ST and TVR. DAPT beyond 1 year was associated with a significantly lower risk for very late ST of G1-DES but not for that of G2-DES