Effects of Xylitol on Urea Synthesis in Patients With Cirrhosis of the Liver

Abstract

Background: In individuals with cirrhosis the normal inhibiting effect of glucose on urea synthesis is lost, probably because of very high concentrations of glucagon. In agreement, glucose does not prevent the inducing effect of glucagon on urea synthesis in normal humans. In contrast, the sugar alcohol, xylitol, prevents the increasing effect of glucagon in normal humans. We, therefore, examined the effect of xylitol on urea synthesis in individuals with cirrhosis and hyperglucagonemia. Methods: Urea synthesis, calculated as urinary excretion rate corrected for accumulation in total body water and intestinal loss, was measured during infusion of alanine (2 mmol/[h·kg body wt]) and during infusion of alanine superimposed on infusion of xylitol (0.12 g/[h·kg body wt]) in 8 individuals with biopsy-proven alcoholic cirrhosis. The functional hepatic nitrogen clearance (FHNC), ie, urea synthesis expressed independent of changes in plasma amino acid concentration, was calculated as the slope of the linear relation between the urea synthesis rate and the plasma amino acid concentration. Results: All individuals had elevated basal plasma glucagon concentration (261 ± 61 ng/L; mean ± SEM) and a markedly increased response to alanine infusion (1037 ± 226 ng/L). This was not changed by xylitol. Neither the basal urea synthesis rate (13.2 ± 2.5 mmol/h) nor the alanine-stimulated urea synthesis rate (76.8 ± 3.64 mmol/h) was changed by xylitol. FHNC during the infusion of alanine alone was 10.5 ± 0.9 L/h and did not change during the concomitant infusion of xylitol (10.1 ± 1.1 L/h). Conclusions: Xylitol reduces neither urea synthesis nor FHNC. The data do not support an important role of xylitol as a nitrogen-sparing agent in cirrhosis. (Journal of Parenteral and Enteral Nutrition 22:320-325, 1998)