Portal de Periódicos da CAPES

A Combined High-Fiber, Low-Glycemic Index Diet Normalizes Glucose Tolerance and Reduces Hyperglycemia and Hyperinsulinemia in Adults with Hepatic Cirrhosis

2002; Elsevier BV; Volume: 102; Issue: 10 Linguagem: Inglês

10.1016/s0002-8223(02)90334-2

1878-3570

Hope Barkoukis, K Fiedler, Edith Lerner,

Diet and metabolism studies

Hepatic cirrhosis is characterized by numerous metabolic abnormalities including abnormal carbohydrate and fatty acid metabolism, altered postabsorptive fuel oxidation patterns, and insulin resistance ( (1) Iverson J. Vilstrup H. Tygstrip N. Kinetics of glucose metabolism in relation to insulin concentrations in patients with alcoholic cirrhosis and in healthy persons. Gastroenterology. 1984; 87: 1136-1143 Google Scholar , (2) Cavallo-Perin P. Cassader M. Bozzo C. Bruno A. Nuccio P. Dallomo A. Marucci M. Mechanisms of insulin resistance in human liver cirrhosis. J Clin Invest. 1985; 75: 1659-1663 Google Scholar , (3) Petrides A. DeFronzo R. Glucose metabolism in cirrhosis. A review with some perspectives for the future. Diab Met. 1989; 5: 691-709 Google Scholar , (4) Petrides A. Reily C. Groop L. DeFronzo R. The glucose fatty-acid cycle does not explain the insulin resistance in cirrhosis. Gastroenterology. 1987; 92: 1763-1768 Google Scholar , (5) Petrides A. Groop L. Reily C. DeFronzo R. Effect of hyperinsulinemia in glucose and lipid metabolism in cirrhosis. Clin Invest. 1991; 88: 561-570 Google Scholar , (6) Mueller M. Williams A. Reiger A. Fenk A. Selberg H. Lautz M. Burger M. Balks S. Schmidt P. Mechanisms of insulin resistance associated with liver cirrhosis. Gastroenterology. 1992; 102: 2033-2041 Google Scholar , (7) Petrides A. Schultz-Berge D. Mathews D. Strohomeyer G. Pathogenesis of glucose intolerance and diabetes mellitus in cirrhosis. Hepatology. 1994; 19: 616-627 Google Scholar , (8) Petrides A. Liver disease and diabetes mellitus. Diab Rev. 1994; 2: 1-17 Google Scholar , (9) Krusynska Y. Harry D. McIntyre N. Bergman R. Insulin sensitivity, insulin secretion and glucose effectiveness in diabetic and non-diabetic cirrhotic patients. Diabetologia. 1993; 36: 121-128 Google Scholar , (10) Riggio O. Merli M. Romiti A. Pinto G. Fanella R. Attili A. Capocaccia L. Early postprandial energy expenditure and micronutrient use after mixed meals in cirrhotic subjects. J Parenter Enteral Nutr. 1992; 16: 445-450 Google Scholar , (11) Owen O. Trapp V. Reichard G.A. Nature and quantity of fuels consumed in patients with alcoholic cirrhosis. J Clin Invest. 1983; 72: 1821-1832 Google Scholar ). The presence of insulin resistance is ubiquitous in hepatic cirrhosis. Investigators utilizing the euglycemic, hyperinsulinemic clamp have observed that in patients with hepatic cirrhosis, insulin resistance occurs independently of the disease severity, etiology, or stage ( (1) Iverson J. Vilstrup H. Tygstrip N. Kinetics of glucose metabolism in relation to insulin concentrations in patients with alcoholic cirrhosis and in healthy persons. Gastroenterology. 1984; 87: 1136-1143 Google Scholar , (2) Cavallo-Perin P. Cassader M. Bozzo C. Bruno A. Nuccio P. Dallomo A. Marucci M. Mechanisms of insulin resistance in human liver cirrhosis. J Clin Invest. 1985; 75: 1659-1663 Google Scholar , (3) Petrides A. DeFronzo R. Glucose metabolism in cirrhosis. A review with some perspectives for the future. Diab Met. 1989; 5: 691-709 Google Scholar , (4) Petrides A. Reily C. Groop L. DeFronzo R. The glucose fatty-acid cycle does not explain the insulin resistance in cirrhosis. Gastroenterology. 1987; 92: 1763-1768 Google Scholar , (5) Petrides A. Groop L. Reily C. DeFronzo R. Effect of hyperinsulinemia in glucose and lipid metabolism in cirrhosis. Clin Invest. 1991; 88: 561-570 Google Scholar , (6) Mueller M. Williams A. Reiger A. Fenk A. Selberg H. Lautz M. Burger M. Balks S. Schmidt P. Mechanisms of insulin resistance associated with liver cirrhosis. Gastroenterology. 1992; 102: 2033-2041 Google Scholar ). Reduced insulin sensitivity appears to be the initial event in carbohydrate metabolism deterioration, with glucose intolerance developing in 60% of this population and diabetes mellitus in 20 percent ( (7) Petrides A. Schultz-Berge D. Mathews D. Strohomeyer G. Pathogenesis of glucose intolerance and diabetes mellitus in cirrhosis. Hepatology. 1994; 19: 616-627 Google Scholar , (8) Petrides A. Liver disease and diabetes mellitus. Diab Rev. 1994; 2: 1-17 Google Scholar ).