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Resting Energy Expenditure of Children With End-stage Chronic Liver Disease Before and After Liver Transplantation

Kyrana, Eirini*,†; Williams, Jane E.; Wells, Jonathan C.; Dhawan, Anil*

Journal of Pediatric Gastroenterology and Nutrition: July 2019 - Volume 69 - Issue 1 - p 102–107
doi: 10.1097/MPG.0000000000002344
Original Articles: Hepatology

Objectives: Our objective was to test the hypothesis that children with end-stage chronic liver disease (ESCLD) are hypermetabolic when compared to healthy children, and that this hypermetabolism persists for at least 6 months after liver transplant.

Methods: Seventeen patients with end-stage chronic liver disease and 14 healthy controls had their resting energy expenditure measured (mREE) by indirect calorimetry. Weight, height, and body mass index were converted to standard deviation (SD) scores. Children older than 5 years had air displacement plethysmography and patients older than 5 years also had whole body dual-energy X-ray absorptiometry with characterization of fat mass (FM), fat-free mass (FFM), and bone-free fat free (lean) mass.

Results: When compared to the prediction equation 44% of the patients and 50% of the healthy controls were hypermetabolic. The younger patients (0–5 years) had a lower mREE than the healthy controls but were significantly lighter and shorter than their healthy counterparts. mREE correlated strongly for all children with age, weight, height, and FFM. There was a strong negative correlation between age and mREE/kg in both patients (rs = −0.94, P < 0.01) and controls (rs = −0.91, P < 0.01). Almost 84% of the variance in mREE was explained by age (P < 0.001). There were no significant differences between resting energy expenditure (REE)/FFM between the 2 groups. mREE/kg before liver transplant correlated with mREE/kg after transplant (Pearson r = 0.83, P < 0.01).

Conclusions: REE mostly reflected the size of the child. The patients were not hypermetabolic when compared to the healthy children. The main determinant of REE/kg after transplant was REE/kg before transplant.

*King's College Hospital NHS Foundation Trust and MowatLabs, London

Leeds Teaching Hospitals NHS Trust, Leeds

MRC Childhood Nutrition Research Centre, Institute of Child Health, London, UK.

Address correspondence and reprint requests to Eirini Kyrana, MDRes, Children's Liver Unit, E Floor, Martin Wing, Leeds Children's Hospital, Leeds LS1 3EX, UK (e-mail:

Received 17 January, 2019

Accepted 13 March, 2019

This work was funded by a joint BSPGHAN/CORE grant and the charity Starfish Appeal.

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,