Effects of eating frequency on respiratory quotient in patients with liver cirrhosis: a randomized controlled trial

Background and Objectives: Respiratory quotient (RQ) is a good marker of substrate oxidation. Low RQ is frequently found in patients with liver cirrhosis and is associated with poor outcome. The purpose of this study was to demonstrate the effects of eating frequency on RQ in patients with cirrhosis. Methods and Study Design: We performed a randomized controlled trial to assess the effects of eating frequency on RQ in patients with cirrhosis. Seventy patients and 30 healthy controls were enrolled, and patients were further randomized to receive either normal eating frequency (NEF) meals at 08:00, 12:00 and 18:00 h, or high eating frequency (HEF) meals at 08:00, 10:00, 12:00, 15:00, 18:00 and 20:00 h. The two groups had equivalent energy intake. Fasting RQ was measured at 07:30 h and daytime RQ was measured at 11:30 and 17:30 h. Disease severity was evaluated using the Child-Turcotte-Pugh (CTP) classification. Results: Fasting RQ and daytime RQ were significantly lower in patients with cirrhosis than in healthy controls. Patients in the HEF group had a higher RQ than patients in the NEF group at three time points. In patients with CTP-A, no significant differences in daytime RQ were observed between the two groups. However, in CTP-C patients, daytime RQ was significantly higher in the HEF group than in the NEF group. Serum free fatty acid levels were significantly decreased and albumin was significantly increased after HEF intervention. Conclusions: HEF strategy is effective in improvement of RQ and is beneficial to patients with cirrhosis.