Effect of Coconut Milk Supplementation to Improve Nutritional Status in Cirrhosis Patient
Effect of Coconut Milk Supplementation to Improve Nutritional Status in Cirrhosis Patient
Liver cirrhosis still becomes a major issue in Indonesia. Malnutrition has been observed in
 liver cirrhosis patients as it deteriorates liver function and cirrhosis itself. Malnutrition
 in liver cirrhosis can increase morbidity and mortality rates.

 Patients with liver cirrhosis have increased energy expenditure and endogenous fat oxidation
 reaction which is used as the basic energy sources. Energy obtained from fat was accounted
 for 86% of the total energy sources in this population. Fatty acid is also known to be an
 efficient energy backup for hepatocytes and other cells because it generates higher adenosine
 triphosphate (ATP) than other sources.

 Supplementary diet for patients with liver cirrhosis is considered beneficial for preventing
 hypercatabolism. To fulfill their nutritional needs, patients with liver cirrhosis is advised
 to take an extra food, such as a late night snack (LNS) with a total carbohydrate of around
 50 g (equivalent to 200 kkal). Considering that most of the energy source in patients with
 liver cirrhosis came from fat, so the additional sources of energy having a high fat content
 were considered to be potentially highly beneficial to address the patients' nutritional
 status, as well as to reduce the risk of hyperglycemia after a meal and hypoglycemia after a
 long night fasting period time.

 Coconut milk contains many saturated fatty acids belonging to the medium chain
 triacylglycerol (MCT) group. The characteristics of MCT are quite different from long chain
 triacylglycerol (LCT). MCTs are more easily absorbed than LCTs, and are mostly absorbed in
 the form of free fatty acids, in both healthy and liver cirrhosis populations.

 This study wants to investigate the effects of coconut milk supplementation on improving the
 nutritional status of patients with liver cirrhosis. The patients were divided into 2 groups,
 groups I received 25 g of sugar plus 50 cc of coconut milk (200 kkal) as late night snacks
 (LNS); and group II received 50 g of sugar alone (200 kkal) as LNS. Investigators think that
 the group who received coconut milk supplementation has better nutritional status than the
 other group.
This study investigated the effects of coconut milk supplementation on improving the
 nutritional status of patients with liver cirrhosis. Design was randomized controlled trial.
 Investigators randomized the patients into 2 groups. Group I received 25 gram of sugar + 50
 cc coconut milk and group II received 50 gram of sugar alone. Both of groups received 200
 kkal as late night snack. Subjects were cirrhosis patients with Child Pugh A and B, who
 develop malnutrition using BMI criteria or experience unintentional weight loss. The outcome
 was nutritional parameters after 1 month supplementation.

 Estimated sample was 60 patients with 30 subjects in group I and 30 subjects in group II.
Inclusion Criteria:

 -  Cirrhosis patients, Child Pugh A and B who are not critically ill, and develop one of
 following condition :

 1. Malnutrition with modified BMI criteria such as BMI < 22 kg/m2 for non ascites,
 BMI < 23 for mild ascites, and BMI < 25 for severe ascites

 2. Unintentional weight loss, defined as decline 5% weight loss for period 6-12
 month or less

 Exclusion Criteria:

 -  Using pace maker

 -  Diabetes mellitus patients

 -  End-stage renal disease