School of Medicine


Body Composition, Nutrition and Metabolism Research

The Body Composition Laboratory was established in 1980 by Professor Graham Hill who served as Director until his retirement in 2000. Since that time it has been directed by Associate Professor Lindsay Plank. A major programme of research in liver disease and liver transplantation has been conducted since 1997 in collaboration with the NZ Liver Transplant Unit. Our research has resulted in oral presentations at 5 of the last 8 ESPEN (European Society for Clinical Nutrition and Metabolism) Congresses and yielded the top-ranked abstract in 2010 and second-ranked abstract in 2005.

Current projects


Effect of beta-blockade on energy metabolism in patients with liver cirrhosis

Lead researchers: Dr Wai Gin Lee, A/Prof Lindsay Plank , Prof John McCall , A/Prof Ed Gane

Many patients with cirrhosis of the liver have a raised metabolic rate which has been shown to predict poorer survival and may be a factor contributing to the progressive malnutrition that generally accompanies the disease. Using a double-blind randomised crossover design this study aims to demonstrate that treatment with oral beta-blockers can reduce metabolic rate in cirrhotic patients. Oral b-blockers are inexpensive, safe and readily available and a positive result from this study provides a strong rationale for further much larger investigation of their potential for improving survival and reducing the demand for liver transplantationFunding support from the Health Research Council of New Zealand, the Auckland Medical Research Foundation and the Faculty Research Development Fund.

Contact: A/Prof. Lindsay Plank

 

Insulin resistance, beta cell function and beta-blockade in liver cirrhosis

Lead researchers: Dr Wai Gin Lee, A/Prof Lindsay Plank , Prof John McCall, Dr Rinki Murphy, A/Prof Ed Gane

Insulin resistance is highly prevalent in cirrhotic patients, a significant proportion being diabetic, and diabetes is associated with increased risk of liver failure. The underlying cause of this insulin resistance and how this is affected by β-blockade is not clear but it is known that β-blockade exacerbates insulin resistance in other conditions. Insights into the mechanisms underlying the insulin resistant state in cirrhosis may provide valuable information with potential therapeutic benefits. Additionally, given the extent to which β-blockade is used for prophylaxis against bleeding in cirrhotic patients, it is important that a better understanding of the effects of this treatment on insulin resistance and diabetes is obtained. The current work utilises euglycaemic-hyperinulinaemic clamp methodology coupled with an intravenous glucose tolerance test with measurements of C-peptide and incretin hormones in a placebo-controlled double-blind crossover design to provide information on insulin resistance, insulin secretion, beta cell function and incretin effects with and without beta-blockade. Funding support from the Health Research Council of New Zealand, the Auckland Medical Research Foundation, the Maurice and Phyllis Paykel Trust, and the Performance Based Research Fund.

Contact: A/Prof Lindsay Plank

 

Bariatric surgery for the morbidly obese: longitudinal changes in body composition

Lead researchers: A/Prof Lindsay Plank , Dr Anne-Thea McGill, A/Prof Sally Poppitt, Mr Grant Beban

Bariatric surgery is now generally recognized as the only effective long-term treatment for morbid obesity (body mass index, BMI >40 kg/m2). This surgery not only induces significant and lasting weight loss but also ameliorates or resolves comorbid disease, especially type 2 diabetes mellitus. This study is aimed at providing a detailed characterisation of the body composition changes that accompany weight loss both before surgery during a very low calorie diet regime and over the 6-month period post-surgery. In particular, changes in total body fat, lean body mass and body cell mass are quantified in the body composition laboratory. The study serves as an important adjunct to the primary trial in which adiponectin and its receptors and other hormonal and metabolic risk factors are measured in blood, adipose, muscle and liver of 25 women accepted for obesity surgery, and the expression of the adiponectin gene and its proteome at these tissue sites before and after weight loss are examined. Funding support from the Faculty Research Development Fund.

Contact: A/Prof Lindsay Plank

 

Immunonutritional therapy in liver transplant patients – a double-blind randomised trial

Lead researchers: Dr Sachin Mathur, A/Prof Lindsay Plank , Prof John McCall, A/Prof Ed Gane

This is the first randomised trial investigating the potential benefits of perioperative nutritional supplementation enriched in n-3 fatty acids, arginine and nucleotides in liver transplant patients.  An earlier pilot study from our group suggested clinical benefit of this supplement that had already been shown in other major surgery. Analysis of the trial results thus far shows that such benefits have not been confirmed and that changes in preoperative nutritional status did not differ between patients on the immunonutrition feed and those on the control product. Funding support from the Health Research Council of New Zealand.

Contact: A/Prof Lindsay Plank

  

Does body composition normalize after liver transplantation?

Lead researchers: Dr Sachin Mathur, A/Prof Lindsay Plank , Prof John McCall, A/Prof Ed Gane

Previous work that we have carried out has shown that recovery of body protein (ie muscle) stores in patients after liver transplantation is poor. One year after their transplant these patients had recovered only about 50% of the body protein that they had lost as a result of this major operation. In addition, the majority of these patients are significantly protein-depleted before their transplant as a consequence of their liver disease. The resulting protein depletion at one year post-transplant has important implications for their return to normal functional activity as well as their susceptibility and response to infection and other stressors. This blunted recovery may, at least in part, be due to the effects of their anti-rejection drugs. The current work investigates body protein status of patients surviving beyond 2 years after transplant who have previously been assessed by our unit around the time of transplantation. Funding support from the Performance Based Research Fund

Contact: A/Prof Lindsay Plank

 

Determinants and prognostic utility of bioimpedance phase angle in patients with liver cirrhosis

Lead researchers: Dr Sachin Mathur, A/Prof Lindsay Plank , Prof John McCall, A/Prof Ed Gane

A number of studies have demonstrated that in clinical situations bioimpedance phase angle (PA) measurements at a single frequency (50 kHz) may have some utility as prognostic indicators for morbidity and mortality. These studies showed that PA is lowered in disease states and is prognostic for survival and for postoperative complications. PA may also be a marker of nutritional status. However, the determinants of PA in a nutritionally compromised population have not been fully elucidated. The current work utilizes detailed body composition information obtained in a large series of patients with cirrhosis to examine relationships between PA and these compositional variables. We are also investigating PA as a predictor of survival in these patients and as a marker of nutritional status in patients who have undergone longitudinal assessments of body composition and functional status.   Funding support from the Faculty Research Development Fund.

Contact: A/Prof Lindsay Plank

 

Application of bioimpedance technology in a multi-ethnic adolescent population.

Lead researchers: John Sluyter, A/Prof Lindsay Plank , Prof Robert Scragg

In a large cross-sectional study of European, Maori, Pacific Island, and Asian volunteers (age 12-19 y) who have undergone whole-body dual-energy X-ray absorptiometry scanning with regional compositional analysis we are investigating the value of segmental bioimpedance measurements coupled with anthropometry for assessing central fat deposition.

Contact: A/Prof Lindsay Plank

  

Preoperative carbohydrate treatment: a Cochrane systematic review and meta-analysis

Lead researchers: Dr Mark Smith, Prof John McCall, A/Prof Lindsay Plank , Mr Matt Soop, Mr Jonas Nygren

We recently completed the largest trial to date investigating the clinical benefits of preoperative carbohydrate loading in major abdominal surgery patients. This trial did not show significant effects for length of stay in hospital or postoperative fatigue in the patient group studied. We are now undertaking a review of all work in this area to establish the extent to which this treatment may impact on postoperative recovery.

Contact: Dr Mark Smith

 

Future research:

We welcome expressions of interest from students in further developing our work on insulin resistance and effects of beta-blockers in cirrhosis, perioperative nutritional interventions to improve recovery from liver transplantation or utility of bioimpedance technology for nutritional assessment.

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