Impairment of albumin and whole body postprandial protein synthesis in compensated liver cirrhosis

To investigate the anabolic effects of feeding in cirrhosis, we measured albumin fractional synthesis rate (FSR) and whole body protein synthesis in six nondiabetic patients with stable liver cirrhosis (three in the Child-Pugh classification Class A, three in Class B) and in seven normal control subjects, before and after administration of a 4-h mixed meal. Leucine tracer precursor-product relationships and whole body kinetics were employed at steady state. Basal levels of postabsorptive albumin concentration and FSR, whole body leucine rate of appearance, oxidation, and nonoxidative leucine disposal (NOLD, approximately equal to protein synthesis) were similar in the two groups. However, after the meal, in the patients neither albumin FSR (from 8.5 +/- 1.5 to 8.8 +/- 1.8 %/day) nor NOLD (from 1.69 +/- 0.22 to 1.55 +/- 0.26 micromol x kg(-1) x min(-1)) changed (P = nonsignificant vs. basal), whereas they increased in control subjects (albumin FSR: from 10.9 +/- 1.5 to 15.9 +/- 1.9 %/day, P < 0.002; NOLD: from 1.80 +/- 0.14 to 2.10 +/- 0.19 micromol x kg(-1) x min(-1), P = 0.032). Thus mixed meal ingestion did not stimulate either albumin FSR or whole body protein synthesis in compensated liver cirrhosis. The mechanism(s) maintaining normoalbuminemia at this disease stage need to be further investigated.