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1 Department of Anesthesiology, Oregon Health Sciences University and Veterans Affairs Medical Center, Portland, Oregon 97201; and 2 United States Department of Agriculture/Agricultural Research Services Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030
On the basis of the
finding that plasma glycerol concentration is not controlled by
clearance in healthy humans, it has been proposed that elevated plasma
free fatty acid (FFA) and glycerol concentrations in cirrhotic subjects
are caused by accelerated lipolysis. This proposal has not been
validated. We infused 10 volunteers, 10 cirrhotic subjects, and 10 patients after orthotopic liver transplantation (OLT) with
[1-13C]palmitate and
[2H5]glycerol to compare fluxes
(Ra) and FFA oxidation. Cirrhotic subjects had higher
plasma palmitate (52%) and glycerol (33%) concentrations than
controls. Palmitate Ra was faster (1.45 ± 0.18 vs. 0.85 ± 0.17 µmol · kg
1 · min
1)
but glycerol Ra and clearance slower (1.20 ± 0.09 vs.
1.90 ± 0.24 µmol · kg
1 · min
1
and 21.2 ± 1.2 vs. 44.7 ± 4.9 ml · kg
· h
1,
respectively) than in controls. After OLT, plasma palmitate and
glycerol concentrations and palmitate Ra did not differ,
but glycerol Ra (1.16 ± 0.11 µmol · kg
1 · min
1)
and clearance (26.7 ± 2.4 ml · kg
· h
1)
were slower than in controls. We conclude that 1) impaired
reesterification, not accelerated lipolysis, elevates FFA in cirrhotic
subjects; 2) normalized FFA after OLT masks impaired
reesterification; and 3) plasma glycerol concentration poorly
reflects lipolytic rate in cirrhosis and after OLT.
palmitate; glycerol; reesterification; insulin; humans
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