Research Article

Effect of a late evening meal on nitrogen balance in patients with cirrhosis of the liver.

BMJ 1989; 299 doi: (Published 11 November 1989) Cite this as: BMJ 1989;299:1202
  1. G. R. Swart,
  2. M. C. Zillikens,
  3. J. K. van Vuure,
  4. J. W. van den Berg
  1. Department of Internal Medicine II, University Hospital Dijkzigt, Rotterdam, The Netherlands.


    OBJECTIVE--To assess whether a late evening meal would improve nitrogen balance in patients with cirrhosis of the liver. DESIGN--Randomised crossover study of meal schedules comparing three meals a day with four or six meals a day, the four and six meal schedules both including a late evening meal (2300). SETTING--Metabolic ward. PATIENTS--Seven men and two women aged 34-66 with cirrhosis of the liver (Child's grade B). INTERVENTIONS--Patients spent two seven day periods in the ward. For five days of each period they received, in random order, isonitrogenous isocaloric diets supplied in three meals a day and in four or six meals a day. MAIN OUTCOME MEASURE--Nitrogen balance, calculated as the difference between dietary intake and the total of urinary, faecal, and integumental nitrogen loss. RESULTS--Faecal nitrogen loss was no different between three meals a day and four or six meals a day. On both four and six meals a day, however, patients had nitrogen balances that were more positive (or less negative) than on three meals a day (1.26 (SD 2.1) g/24 h v 0.26 (2.2) g/24 h, p less than 0.01). Six meals a day did not produce significantly better improvements in nitrogen balance than four meals a day. CONCLUSIONS--A late evening meal seemed to improve the efficiency of nitrogen metabolism, but longer term studies are needed to assess whether this leads to a better nutritional state.