Effect of a late evening meal on nitrogen balance in patients with cirrhosis of the liver

Abstract

Objective - To assess whether a late evening meal would improve nitrogen balance in patients with cirrhosis of the liver. Design - Randomised crossover study of meal schedules comparing three meals a day with four or six meals a day, the four and six meal schedules both including a late evening meal (2300). Setting - Metabolic ward. Patients - Seven men and two women aged 34-66 with cirrhosis of the liver (Child's grade B). Interventions - Patients spent two seven day periods in the ward. For five days of each period they received, in random order, isonitrogenous isocaloric diets supplied in three meals a day and in four or six meals a day. Main outcome measure - Nitrogen balance, calculated as the difference between dietary intake and the total of urinary, faecal, and integumental nitrogen loss. Results - Faecal nitrogen loss was no different between three meals a day and four or six meals a day. On both four and six meals a day, however, patients had nitrogen balances that were more positive (or less negative) than on three meals a day (1.26 (SD 2.1) g/24 h v 0.26 (2.2) g/24 h, p < 0.01). Six meals a day did not produce significantly better improvements in nitrogen balance then four meals a day. Conclusions - A late evening meal seemed to improve the efficiency of nitrogen metabolism, but longer term studies are needed to assess wether this leads to a better nutritional state.