Abstract
The purpose of this study was to assess the fatty acid profile of adipose tissue in malnourished patients with chronic liver disease before and after liver transplantation using carbon-13 magnetic resonance spectroscopy (13C MRS), a noninvasive, in vivo technique. Twenty-two patients with histologically proven cirrhosis undergoing liver transplantation were evaluated before and eight weeks after transplantation. An equal number of healthy, matched controls were also evaluated. Body weight, body mass index, triceps skinfold thickness, and mid-upper arm circumference were determined. Fasting blood samples were analyzed for blood count, biochemical profile, lipid concentrations, glucose levels, liver function tests, and coagulation. Patients were nutritionally assessed using objective and clinical indicators. 13C MR spectra were obtained from the subcutaneous adipose tissue of the thigh from all subjects. In addition, adipose tissue samples were obtained from 11 of the liver transplant recipients (all with cholestatic liver disease) at the time of transplantation and from 4 control subjects during hernia repair. Profiles of individual fatty acids were analyzed from these samples by gas-liquid chromatography (GLC). Pretransplant patients with cholestatic liver diseases had lower serum high-density lipoprotein concentrations and higher levels of serum total and low-density lipoprotein cholesterol compared with patients with other types of liver failure. Based on anthropometric measurements, patients with cirrhosis had depleted fat and muscle stores compared with the healthy controls. However, there were no differences in percentages of saturated, polyunsaturated, or monounsaturated fatty acids in subcutaneous fatty tissue between pretransplant patients and controls based on 13C MRS results. GLC evaluation of fatty tissue samples obtained at time of surgery confirmed these results and, in addition, identified differences in individual fatty acids between the control and cirrhotic patients. The percentage of n-3 fatty acids was 0.84% ± 0.07% in patients with cirrhosis and 1.36% ± 0.13% in the healthy, control patients. After transplantation, liver function tests improved. Body mass, body fat, and muscle stores increased significantly by the eighth posttransplant week, reaching levels similar to the control group. Finally, after transplantation there was an increase in saturated fatty acid levels (21.0% ± 2.8% pretransplant vs 25.5% ± 1.2% posttransplant) and a decrease in unsaturated fatty acid levels (78.4% ± 2.8% pretransplant vs 74.5% ± 1.2% posttransplant) in adipose tissue.
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