J Clin Med Res

Journal of Clinical Medicine Research, ISSN 1918-3003 print, 1918-3011 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Clin Med Res and Elmer Press Inc

Journal website http://www.jocmr.org

Original Article

Volume 8, Number 12, December 2016, pages 863-869

Effect of L-Carnitine in Patients With Liver Cirrhosis on Energy Metabolism Using Indirect Calorimetry: A Pilot Study

Figure 1. Changes in the non-protein respiratory quotient (npRQ) before and after 4 weeks of L-carnitine therapy. (a) For all cases (n = 13), the npRQ value at 4 weeks increased as compared with the baseline levels, although the difference was not significant (P = 0.12). (b) In patients with baseline npRQ < 0.85 (n = 7), the npRQ value significantly increased as compared with the baseline levels after 4 weeks of L-carnitine treatment (P = 0.016).

Figure 2. Changes in energy metabolism before and after L-carnitine therapy. (a) For all cases, the mean %C was 37.6%, the mean %F was 40.2% and the mean %P was 22.2% at the time of L-carnitine therapy. After 4 weeks of L-carnitine therapy, the mean %C increased to 48.2%, the mean %F decreased to 31.9% and the mean %P decreased to 19.9%, which indicated an improvement in energy metabolism. (b) In a subgroup analysis of patients with baseline npRQ < 0.85, the mean %C was 15.3%, the mean %F was 59.9% and the mean %P was 24.8% at the time of L-carnitine therapy. After 4 weeks of L-carnitine therapy, the mean %C increased to 34.2%, the mean %F decreased to 45.1% and the mean %P decreased to 20.6%, suggesting an improvement in energy metabolism. Data are expressed as mean values.

Figure 3. Changes in high-sensitivity C-reactive protein (hsCRP) levels between baseline and 4 weeks. (a) For all patients, the hsCRP level at 4 weeks significantly decreased as compared with the hsCRP level at baseline (P = 0.022). (b) In patients with a npRQ value < 0.85, the hsCRP level at 4 weeks tended to decrease as compared with the hsCRP level at baseline (P = 0.11).

**Table 1.** Changes of Parameters Before and After 4 Weeks of L-Carnitine Therapy (n = 13)
Variables	Baseline	At 4 weeks	P value^a
Data are presented as mean ± standard deviation. %C: substrate oxidation rates of carbohydrate; %F: substrate oxidation rates of fat; %P: substrate oxidation rates of protein; BCAA: branched chain amino acid; IRI: immune reactive insulin; HOMA-IR: homeostasis model assessment-insulin resistance. ^aPaired t-test.
Total carnitine (μmol/L)	71.0 ± 14.7	105.5 ± 30.0	< 0.001
Free carnitine (μmol/L)	54.5 ± 13.8	77.9 ± 23.1	< 0.001
Acyl carnitine (μmol/L)	16.5 ± 3.9	27.6 ± 9.0	< 0.001
Non-protein respiratory quotient	0.838 ± 0.097	0.868 ± 0.060	0.19
Rest energy expenditure (kcal/day)	1,402.4 ± 239.1	1,379.9 ± 265.3	0.33
%C	37.6 ± 30.0	48.2 ± 18.3	0.12
%F	40.2 ± 26.6	31.9 ± 23.7	0.20
%P	22.2 ± 15.3	19.9 ± 15.9	0.48
Free fatty acid (μEq/L)	669.6 ± 198.1	846.2 ± 192.5	0.003
Total cholesterol (mg/dL)	171.8 ± 43.3	177.2 ± 45.5	0.16
Triglyceride (mg/dL)	66.1 ± 25.3	70.4 ± 33.8	0.19
Body weight (kg)	62.7 ± 13.6	63.0 ± 13.8	0.09
Serum albumin (g/dL)	3.22 ± 0.50	3.29 ± 0.58	0.32
Serum prealbumin (mg/dL)	9.85 ± 2.74	10.12 ± 3.33	0.41
BCAA to tyrosine ratio	3.16 ± 0.87	3.35 ± 1.14	0.49
Fasting blood glucose (mg/dL)	111.5 ± 19.2	113.2 ± 19.2	0.57
IRI (μU/mL)	14.6 ± 10.2	12.1 ± 7.5	0.17
HOMA-IR	3.97 ± 2.75	3.36 ± 2.04	0.23
Serum ammonia (μg/dL)	65.8 ± 49.1	61.4 ± 45.4	0.53

Table 1. Changes of Parameters Before and After 4 Weeks of L-Carnitine Therapy (n = 13)

Variables

Baseline

At 4 weeks

P value^a

Data are presented as mean ± standard deviation. %C: substrate oxidation rates of carbohydrate; %F: substrate oxidation rates of fat; %P: substrate oxidation rates of protein; BCAA: branched chain amino acid; IRI: immune reactive insulin; HOMA-IR: homeostasis model assessment-insulin resistance. ^aPaired t-test.

Total carnitine (μmol/L)

71.0 ± 14.7

105.5 ± 30.0

< 0.001

Free carnitine (μmol/L)

54.5 ± 13.8

77.9 ± 23.1

< 0.001

Acyl carnitine (μmol/L)

16.5 ± 3.9

27.6 ± 9.0

< 0.001

Non-protein respiratory quotient

0.838 ± 0.097

0.868 ± 0.060

0.19

Rest energy expenditure (kcal/day)

1,402.4 ± 239.1

1,379.9 ± 265.3

0.33

37.6 ± 30.0

48.2 ± 18.3

0.12

40.2 ± 26.6

31.9 ± 23.7

0.20

22.2 ± 15.3

19.9 ± 15.9

0.48

Free fatty acid (μEq/L)

669.6 ± 198.1

846.2 ± 192.5

0.003

Total cholesterol (mg/dL)

171.8 ± 43.3

177.2 ± 45.5

0.16

Triglyceride (mg/dL)

66.1 ± 25.3

70.4 ± 33.8

0.19

Body weight (kg)

62.7 ± 13.6

63.0 ± 13.8

0.09

Serum albumin (g/dL)

3.22 ± 0.50

3.29 ± 0.58

0.32

Serum prealbumin (mg/dL)

9.85 ± 2.74

10.12 ± 3.33

0.41

BCAA to tyrosine ratio

3.16 ± 0.87

3.35 ± 1.14

0.49

Fasting blood glucose (mg/dL)

111.5 ± 19.2

113.2 ± 19.2

0.57

IRI (μU/mL)

14.6 ± 10.2

12.1 ± 7.5

0.17

HOMA-IR

3.97 ± 2.75

3.36 ± 2.04

0.23

Serum ammonia (μg/dL)

65.8 ± 49.1

61.4 ± 45.4

0.53

**Table 2.** Changes of Parameters Before and After 4 Weeks of L-Carnitine Therapy in Patients With npRQ < 0.85 (n = 7)
Variables	Baseline	At 4 weeks	P value^a
Data are presented as mean ± standard deviation. %C: substrate oxidation rates of carbohydrate; %F: substrate oxidation rates of fat; %P: substrate oxidation rates of protein; BCAA: branched chain amino acid; IRI: immune reactive insulin; HOMA-IR: homeostasis model assessment-insulin resistance. ^aPaired t-test.
Total carnitine (μmol/L)	65.9 ± 16.5	107.3 ± 33.9	0.001
Free carnitine (μmol/L)	49.2 ± 15.9	76.5 ± 25.7	0.001
Acyl carnitine (μmol/L)	16.7 ± 3.0	30.8 ± 10.3	0.006
Non-protein respiratory quotient	0.760 ± 0.043	0.827 ± 0.030	0.016
Rest energy expenditure (kcal/day)	1,368.1 ± 195.2	1,312.8 ± 311.5	0.25
%C	15.3 ± 15.4	34.2 ± 6.7	0.019
%F	59.9 ± 16.9	45.1 ± 21.7	0.073
%P	24.8 ± 17.3	20.6 ± 20.5	0.49
Free fatty acid (μEq/L)	761.0 ± 147.7	909.6 ± 136.6	0.069
Total cholesterol (mg/dL)	184.4 ± 44.3	185 ± 48.0	0.92
Triglyceride (mg/dL)	65.1 ± 19.4	65.4 ± 21.1	0.92
Body weight (kg)	57.1 ± 14.8	57.2 ± 14.7	0.67
Serum albumin (g/dL)	3.06 ± 0.39	3.06 ± 0.36	> 0.99
Serum prealbumin (mg/dL)	9.1 ± 3.0	9.5 ± 4.0	0.45
BCAA to tyrosine ratio	2.97 ± 0.72	3.33 ± 1.42	0.47
Fasting blood glucose (mg/dL)	111.7 ± 25.5	116.4 ± 22.8	0.34
IRI (μU/mL)	9.3 ± 4.7	9.3 ± 4.3	0.93
HOMA-IR	2.51 ± 1.23	2.67 ± 1.23	0.43
Serum ammonia (μg/dL)	48.3 ± 33.4	41.6 ± 16.6	0.51

Table 2. Changes of Parameters Before and After 4 Weeks of L-Carnitine Therapy in Patients With npRQ < 0.85 (n = 7)

Variables

Baseline

At 4 weeks

P value^a

Total carnitine (μmol/L)

65.9 ± 16.5

107.3 ± 33.9

0.001

Free carnitine (μmol/L)

49.2 ± 15.9

76.5 ± 25.7

0.001

Acyl carnitine (μmol/L)

16.7 ± 3.0

30.8 ± 10.3

0.006

Non-protein respiratory quotient

0.760 ± 0.043

0.827 ± 0.030

0.016

Rest energy expenditure (kcal/day)

1,368.1 ± 195.2

1,312.8 ± 311.5

0.25

15.3 ± 15.4

34.2 ± 6.7

0.019

59.9 ± 16.9

45.1 ± 21.7

0.073

24.8 ± 17.3

20.6 ± 20.5

0.49

Free fatty acid (μEq/L)

761.0 ± 147.7

909.6 ± 136.6

0.069

Total cholesterol (mg/dL)

184.4 ± 44.3

185 ± 48.0

0.92

Triglyceride (mg/dL)

65.1 ± 19.4

65.4 ± 21.1

0.92

Body weight (kg)

57.1 ± 14.8

57.2 ± 14.7

0.67

Serum albumin (g/dL)

3.06 ± 0.39

3.06 ± 0.36

> 0.99

Serum prealbumin (mg/dL)

9.1 ± 3.0

9.5 ± 4.0

0.45

BCAA to tyrosine ratio

2.97 ± 0.72

3.33 ± 1.42

0.47

Fasting blood glucose (mg/dL)

111.7 ± 25.5

116.4 ± 22.8

0.34

IRI (μU/mL)

9.3 ± 4.7

9.3 ± 4.3

0.93

HOMA-IR

2.51 ± 1.23

2.67 ± 1.23

0.43

Serum ammonia (μg/dL)

48.3 ± 33.4

41.6 ± 16.6

0.51