Measured QOL was analyzed by z-test or Student’s t-test between each group. Data analysis was performed using JMP ver. 5.1J (SAS Institute Japan, Tokyo, Japan) and P < 0.05 was considered statistically significant. THE MEAN BMI of all patients with liver cirrhosis was 23.1 ± 3.4 kg/m2.

The ratio of obese subjects with BMI of 25 or higher was 30.6% and that of less than 18.5 kg/m2 was 5.1%, respectively check details (Fig. 1). We then excluded patients with ascites, edema or HCC to match the present cohort with those reported in 2002.[4] The number of patents in this cohort was 95, and Child–Pugh grades A, B and C were 71:22:2, respectively. Mean BMI was 23.6 ± 3.6 kg/m2, and BMI of less than 18.5 kg/m2 and 25.0 kg/m2 or higher were observed in 9.2% and 33.7%, respectively (Fig. 2). We examined nutritional status in 181 patients with liver cirrhosis that underwent indirect calorimetry. In these patients, the male : female ratio was 112:69, HCC was present in 94, and Child–Pugh grades A : B : C were 90:58:33. When protein malnutrition was defined as serum albumin level of less than 3.5 g/dL and energy malnutrition as a non-protein respiratory quotient of less than 0.85, protein malnutrition was found in 61%, energy malnutrition

in 43% and PEM in 27% (Table 2). Similarly, among 87 patients without HCC (Child–Pugh grades A : B : C, 36:27:24), 67% had protein malnutrition, 48% had energy malnutrition and 30% had PEM (Table 3). We examined health-related QOL in 114 patients with liver cirrhosis (64 BGB324 order men and 50 women) using the SF-8. Sixty-two patients had HCC, and Child–Pugh grades A : B : C were 63:26:25. Quality of life of all subjects was significantly lower on all subscales than Japanese national standard values (Table 4),[24] but no difference was observed between the presence and the absence of HCC (Table 5). PROTEIN-ENERGY

MALNUTRITION is a common manifestation in cirrhotic patients with reported incidences as high as 50–87%.[1, 2] Protein nutrition is usually evaluated by serum albumin level and, for energy nutrition, indirect Florfenicol calorimetry is recommended for precise analysis.[13] Energy malnutrition typically shows reduced carbohydrate oxidation, increased fat oxidation and decline in npRQ measured by indirect calorimetry. It is reported that PEM worsens prognosis and QOL in patients with liver cirrhosis.[3, 4] Thus, intervention for PEM is an important issue in the clinical management of liver cirrhosis. For this purpose, BCAA administration for protein malnutrition raises the serum albumin level and improves QOL and survival of patients with liver cirrhosis.[5-8] LES for energy malnutrition improves npRQ, liver dysfunction and QOL.[9, 10] Thus, many guidelines[11-13] recommend such nutritional therapy for liver cirrhosis.