Effect of branched-chain amino acid supplements on muscle strength and muscle mass in patients with liver cirrhosis

Uojima, Haruki; Sakurai, Seiko; Hidaka, Hiroyoshi; Kinbara, Takeshi; Sung, Ji Hyun; Ichita, Chikamasa; Tokoro, Shinnosuke; Masuda, Sakue; Sasaki, Akira; Koizumi, Kazuya; Egashira, Hideto; Kako, Makoto; Kobayashi, Shuzo

doi:10.1097/meg.0000000000000968

Cited by 40 publications

(37 citation statements)

References 26 publications

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“…Actually, we have reported that branched chain amino acid (BCAA) supplementation significantly improved protein nutrition and, subsequently, prognosis for sarcopenia patients with liver cirrhosis (29). BCAA supplementation is reported to improve low muscle strength in patients with chronic liver disease (30). Sarcopenia and decreased serum BCAA levels were predictors of minimal hepatic encephalopathy, which spoils QOL (31).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of Sarcopenia and Its Relationship with Nutritional State and Quality of Life in Patients with Digestive Diseases

Onishi

Shiraki

Nishimura

et al. 2018

J Nutr Sci Vitaminol

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This study aimed to clarify the prevalence of sarcopenia, which is characterized by loss of skeletal muscle mass and strength, and its relationship with nutritional state and quality of life (QOL) in patients with digestive diseases. This study enrolled 303 patients (187 men and 116 women with a median age of 70 y) having digestive diseases. Diseases were gastrointestinal in 99 patients, biliary/pancreatic in 93, and hepatic in 111. Skeletal muscle cross-sectional area was measured by abdominal computed tomography at the 3rd vertebra (L3) level. Sarcopenia was defined using the L3 skeletal muscle index and hand grip strength. Nutritional state was assessed by Subjective Global Assessment (SGA), Mini nutritional Assessment ®-Short Form (MNA ®-SF), anthropometry, and blood biochemistry. QOL was evaluated by Short Form-8 TM. Prevalence of sarcopenia was 32.0% in overall cases. The value was 22.2% in gastrointestinal disease, 36.6% in biliary/pancreatic disease, and 36.9% in hepatic disease. Advanced age, male sex, and advanced cancer state were associated with development of sarcopenia. Patients with sarcopenia had a significantly worse nutritional state according to SGA and MNA ®-SF than those without sarcopenia. In anthropometry, % arm muscle area, % calf circumference, and body mass index were significantly lower in the sarcopenic group. Serum albumin and hemoglobin were also significantly lower in the sarcopenia patients. QOL was more impaired in physical component subscales in sarcopenia patients than non-sarcopenia ones. Patients with digestive diseases frequently suffer from sarcopenia and this is associated with worsening of nutritional state and QOL in these patients.

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Section: Discussionmentioning

confidence: 99%

Prevalence of Sarcopenia and Its Relationship with Nutritional State and Quality of Life in Patients with Digestive Diseases

Onishi

Shiraki

Nishimura

et al. 2018

J Nutr Sci Vitaminol

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“…Protein-energy malnutrition is a common characteristic in cirrhotic patients [ 29 ]. BCAA supplement served as substrates for protein synthesis, and important regulators of protein synthesis are effective in improving nitrogen balance and finally resulting in better clinical outcomes [ 30 ]. Some clinical trials also have demonstrated the effect of BCAAs in patients with hepatic encephalopathy [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Effects of Late Evening Snack on Cirrhotic Patients: A Systematic Review and Meta-Analysis

Guo

Tian

Jiang

et al. 2018

Gastroenterology Research and Practice

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Background Energetic effects of late evening snack (LES) on cirrhotic patients were reported recently, but there was no quantitative analysis. In this meta-analysis, we reviewed and quantified the effects of LES on energy metabolism and substrate oxidation in the patients with cirrhosis, which will be of benefit for liver cirrhosis nutritional therapy. Methods A systematic search was conducted in PubMed, Embase, Web of Science, Elsevier, China National Knowledge Infrastructure, and Wanfang Database for relevant trials published until July 2017. These studies statistically were combined and analyzed by RevMan 5.3. Results Fourteen trials comprising 478 cases were eligible for analysis. The results showed that the respiratory quotient value (MD = 11.09) and carbohydrate oxidation value (MD = 0.05) significantly elevated with one week or with up to three weeks of LES treatment in cirrhotic patients (P < 0.05). Meanwhile, the levels of serum albumin (MD = 2.98) and cholinesterase (SMD = 1.09) were increased with LES administration for three weeks or that lasting twelve weeks (P < 0.05). However, there was no significant improvement for the levels of alanine aminotransferase (ALT) (P = 0.53), aspartate aminotransferase (AST) (P = 0.96), and total bilirubin (TB) (P = 0.32). Conclusions LES could improve the energy malnutrition state of cirrhotic patients. However, it may have little effect on reducing liver parenchymal injury indexes such as serum aminotransferase.

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“…Several small Japanese studies have assessed whether BCAA supplementation improves or prevents sarcopenia in cirrhotic patients; however, most of these are limited by low patient numbers, confounding, poor long-term follow-up, and lack of appropriate control groups 65,66 . Hiraoka et al prospectively studied 33 patients with cirrhosis who underwent BCAA supplementation as a late evening snack and also walking exercise (additional 2000 steps/day), over a three-month period 65 .…”

Section: Branched-chain Amino Acid Supplementationmentioning

confidence: 99%

“…Uojima et al prospectively studied 82 cirrhotic patients with persistent hypoalbuminemia (albumin <3.5 g/dL) after undergoing standard nutrition therapy for at least 28 days, who then underwent BCAA supplementation for 24 weeks and again acted as their own controls 66 . After completing the study period, participants had improved muscle strength as measured by hand-grip strength test (pre-treatment 22.2 ± 6.3 kg, post-treatment 23.9 ± 6.4 kg, p<0.001); however, there was no difference in skeletal muscle mass index as measured by bioelectrical impedance analysis divided by height squared (pre-treatment 7.40 ± 1.62, post-treatment 7.30 ± 1.49, p = 0.333).…”

Section: Branched-chain Amino Acid Supplementationmentioning

confidence: 99%

“…Overall, the impact of BCAA supplementation in sarcopenic cirrhotic patients remains enticing but under-studied. It is a relatively benign intervention with few side effects and low risk profile, but its efficacy has not been addressed with an RCT or prospective study of US participants 63,65,66 . Given the dietary differences between Asian and US populations, it will be important to study BCAA in a US population before its practice can be adopted.…”

Section: Branched-chain Amino Acid Supplementationmentioning

confidence: 99%

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Sarcopenia in Liver Transplantation

Montgomery

Englesbe

2019

Curr Transpl Rep

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Purpose of Review: Sarcopenia is highly prevalent in end-stage liver disease (ESLD) patients and has been linked to poor outcomes on the wait list and post-transplantation. This current perspectives article reviews the ongoing challenges to define sarcopenia in ESLD patients, describes associations of sarcopenia with wait-list and post-transplantation outcomes, and provides summarized data on efforts to prevent and treat sarcopenia through novel interventions. Recent Findings: Supervised exercise programs improve muscle strength, but muscle mass outcomes are limited by short study follow-up times. Branched chain amino acid supplementation may ameliorate sarcopenia in ESLD patients, but studies limited by low participant numbers and confounding. Myostatin inhibition shown to improve sarcopenia in elderly, frail patients; further study needed in ESLD patients. Correction of low testosterone improves sarcopenia in male ESLD patients. Summary: Recent literature supports sarcopenia as an independent risk factor for poor outcomes in ESLD patients. Ongoing study is limited by poor standardization of sarcopenia definition and relevant muscle-mass cutoffs. Supervised exercise programs should be encouraged for all ESLD patients. More advanced therapies require further clinical investigation before their widespread use.

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Effect of branched-chain amino acid supplements on muscle strength and muscle mass in patients with liver cirrhosis

Abstract: BCAA supplementation improved low muscle strength in patients with chronic liver disease, but did not increase muscle mass during the treatment period.

Cited by 40 publications

References 26 publications

Prevalence of Sarcopenia and Its Relationship with Nutritional State and Quality of Life in Patients with Digestive Diseases

Prevalence of Sarcopenia and Its Relationship with Nutritional State and Quality of Life in Patients with Digestive Diseases

Effects of Late Evening Snack on Cirrhotic Patients: A Systematic Review and Meta-Analysis

Sarcopenia in Liver Transplantation

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