However, these evidences were obtained more than 10 years ago when malnutrition prevailed. In recent years, the impact of obesity on liver damage and carcinogenesis has grown. We attempted to elucidate the nutritional

state and QOL in present cirrhotics. A research group supported by the Ministry of Health, Labor and Welfare of Japan recruited 294 cirrhotics between 2007 and 2011. Subjects comprised 171 males and 123 females, 158 of whom had hepatocellular carcinoma (HCC) and Child–Pugh grades A : B : C were 154:91:49. Anthropometry, blood biochemistry and indirect calorimetry were conducted, and QOL was measured using Short Form-8. The mean body mass index (BMI) of all patients was 23.1 ± 3.4 kg/m2, and 31% showed obesity (BMI ≥ 25.0). In Dinaciclib in vitro subjects without ascites, edema or HCC, mean BMI was 23.6 ± 3.6, and 34% had obesity. Protein malnutrition defined as serum albumin of less than 3.5 g/dL and energy malnutrition as respiratory quotient Y-27632 mw of less than 0.85 appeared in 61% and 43%, respectively, and protein-energy malnutrition (PEM) in 27% of all subjects. Among

subjects without HCC, each proportion was 67%, 48% and 30%, respectively. QOL was significantly lower on all subscales than Japanese national standard values, but was similar regardless the presence or absence of HCC. While PEM is still present in liver cirrhosis, an equal proportion has check details obesity in recent patients. Thus, in addition to guidelines for PEM, establishment of

nutrition and exercise guidelines seems essential for obese patients with liver cirrhosis. BECAUSE THE LIVER plays the central role in nutrient and fuel metabolism, protein-energy malnutrition (PEM) is common in patients with liver cirrhosis.[1, 2] Moreover, such malnutrition leads to poor prognosis and decline in the quality of life (QOL) of cirrhotics.[3, 4] Branched-chain amino acid (BCAA) administration for protein malnutrition raises the serum albumin level and improves the QOL and survival of patients with liver cirrhosis.[5-8] Treatment with late-evening snack (LES) for energy malnutrition improves respiratory quotient (RQ), liver dysfunction and QOL.[9, 10] Therefore, the guidelines for the treatment of liver cirrhosis by Japanese Society of Gastroenterology,[11] American Society for Parenteral and Enteral Nutrition[12] and European Society for Clinical Nutrition and Metabolism[13] recommend such nutritional therapy. However, these evidences were obtained in the cirrhotic patients recruited from 1995–2000, where protein or energy malnutrition prevailed in 50–87%.[1-4] In contrast, in the next 10 years, obesity rate in the cirrhotic patients rose to approximately 30%.[14] More recently, non-alcoholic steatohepatitis (NASH) or the hepatic inflammation, fibrosis and carcinogenesis due to obesity became the topics.