A Randomized Clinical Trial of Preoperative Administration of Branched-Chain Amino Acids to Prevent Postoperative Ascites in Patients with Liver Resection for Hepatocellular Carcinoma

Kikuchi, Yutaro; Hiroshima, Yukihiko; Matsuo, Keitaro; Kawaguchi, Daisuke; Murakami, Takashi; Yabushita, Yasuhiro; Endo, Itaru; Taguri, Masataka; Koda, Keiji; Tanaka, Kuniya

doi:10.1245/s10434-016-5348-3

Cited by 32 publications

(64 citation statements)

References 31 publications

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“…In fact, BCAAs stimulates insulin production and glucose uptake from liver and SM cells [135]. Furthermore, BCAAs supplementation in obese cirrhotic men reduces the development of HCC and enhances the survival rate [136,137]. Moreover, it potentiates the antitumor effects of sorafenib in patients with advanced HCC [138].…”

Section: High Protein Diet In Nafld Cure or Disease?mentioning

confidence: 99%

High Protein Diet and Metabolic Plasticity in Non-Alcoholic Fatty Liver Disease: Myths and Truths

2019

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Non-alcoholic fatty liver disease (NAFLD) is characterized by lipid accumulation within the liver affecting 1 in 4 people worldwide. As the new silent killer of the twenty-first century, NAFLD impacts on both the request and the availability of new liver donors. The liver is the first line of defense against endogenous and exogenous metabolites and toxins. It also retains the ability to switch between different metabolic pathways according to food type and availability. This ability becomes a disadvantage in obesogenic societies where most people choose a diet based on fats and carbohydrates while ignoring vitamins and fiber. The chronic exposure to fats and carbohydrates induces dramatic changes in the liver zonation and triggers the development of insulin resistance. Common believes on NAFLD and different diets are based either on epidemiological studies, or meta-analysis, which are not controlled evidences; in most of the cases, they are biased on test-subject type and their lifestyles. The highest success in reverting NAFLD can be attributed to diets based on high protein instead of carbohydrates. In this review, we discuss the impact of NAFLD on body metabolic plasticity. We also present a detailed analysis of the most recent studies that evaluate high-protein diets in NAFLD with a special focus on the liver and the skeletal muscle protein metabolisms.

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Section: High Protein Diet In Nafld Cure or Disease?mentioning

confidence: 99%

High Protein Diet and Metabolic Plasticity in Non-Alcoholic Fatty Liver Disease: Myths and Truths

2019

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“…In another study of patients with liver cirrhosis, high-protein (1.2 g/kg) and high-fiber (30 g fiber) diets with a BCAA preparation increased muscle mass and prevented hepatic coma [ 99 ]. In patients with hepatocellular carcinoma (HCC) who underwent liver resection, the use of BCAA was effective in preventing ascites and pleural effusion [ 100 ]. In related studies conducted in patients with liver cirrhosis, long-term BCAA therapy improved bilirubin levels, Child-Pugh scores, albumin levels, and survival rates [ 101 , 102 ].…”

Section: Ascites Due To Cirrhosismentioning

confidence: 99%

KASL clinical practice guidelines for liver cirrhosis: Ascites and related complications

2018

Clin Mol Hepatol

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“…30 Togo et al 9 showed early recovery of protein metabolism after hepatectomy in patients who received BCAA granules. Kikuchi et al 5 reported that BCAA reduced the frequency of postoperative ascites. Ichikawa et al 10 showed the effectiveness of BCAA on the 30-month recurrence rate, although no significant difference was found in the 4-year RFS.…”

Section: Discussionmentioning

confidence: 99%

“…24 In addition, it was shown that BCAA exerted anti-angiogenic activity by suppressing the expression of vascular endothelial growth factor in HCC cell lines and in the tumors implanted in the rat liver. 25,26 Previous reports have suggested the efficacy of BCAA granules in patients who have received treatment for HCC, including patients treated by surgery, 5,[7][8][9][10] RFA, 11,12 hepatic arterial infusion therapy (HAIC), 27 TACE, 28 radiotherapy, 29 and molecular target-based therapy. 30 Togo et al 9 showed early recovery of protein metabolism after hepatectomy in patients who received BCAA granules.…”

Section: Discussionmentioning

confidence: 99%

“…4 Preoperative administration of BCAA in patients undergoing hepatic operation has been shown to be effective for preventing ascites, pleural effusion, or both, as well as for improving albumin metabolism, and reducing the risk of complications and duration of hospital stay. 5,6 Previous reports have addressed the effects of BCAA on HCC recurrence after curative treatments, including surgery [7][8][9][10] and radiofrequency ablation (RFA), [11][12][13][14] however, no definitive conclusions have been reached. The present study was conducted to determine whether postoperative oral administration of BCAA is effective for preventing HCC recurrence after liver resection in a randomized clinical setting.…”

Section: Introductionmentioning

confidence: 99%

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Effects of branched‐chain amino acids on postoperative tumor recurrence in patients undergoing curative resection for hepatocellular carcinoma: A randomized clinical trial

Hachiya

Aoki

Iso

et al. 2020

J Hepato Biliary Pancreat

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Background/Purpose: No effective postoperative adjuvant therapies have been established for patients with hepatocellular carcinoma (HCC). The aim of this study was to investigate the effect of oral administration of branched-chain amino acids (BCAA) on the recurrence-free survival (RFS) after hepatic resection in HCC patients. Methods: In this randomized clinical trial, HCC patients undergoing curative resections were randomly assigned in a 1:1 ratio to the BCAA group or surgery-alone group. The BCAA group received BCAA (Livact ®) for up to 4 years. The primary endpoint was RFS. The secondary endpoint was overall survival (OS). Multivariate analysis was performed to detect the clinical characteristics significantly associated with RFS. Results: Between January 2010 and October 2014, 156 patients (75 in BCAA group and 81 in surgery-alone group) were enrolled in the study. Of these, two patients were excluded from the efficacy analysis. Comparison of the survival curves by the log rank test demonstrated no significant difference in the RFS (P = .579) or OS (P = .268) between the BCAA and the control group. Multivariate analysis revealed that the RFS was significantly associated with age and number of tumors. A beneficial effect of BCAA on the RFS was found in patients younger than 72 years old with a HbA1c level of < 6.4%. Conclusions: Oral BCAA supplementation could not reduce the risk of recurrence after hepatic resection in HCC patients; however, the results suggested that BCAA supplementation may be beneficial for selected patients who were younger and had mildly impaired glucose tolerance.

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A Randomized Clinical Trial of Preoperative Administration of Branched-Chain Amino Acids to Prevent Postoperative Ascites in Patients with Liver Resection for Hepatocellular Carcinoma

Cited by 32 publications

References 31 publications

High Protein Diet and Metabolic Plasticity in Non-Alcoholic Fatty Liver Disease: Myths and Truths

High Protein Diet and Metabolic Plasticity in Non-Alcoholic Fatty Liver Disease: Myths and Truths

KASL clinical practice guidelines for liver cirrhosis: Ascites and related complications

Effects of branched‐chain amino acids on postoperative tumor recurrence in patients undergoing curative resection for hepatocellular carcinoma: A randomized clinical trial

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