Late Evening Snack with Branched-Chain Amino Acids Supplementation Improves Survival in Patients with Cirrhosis

Abstract

The clinical efficacy of a late evening snack (LES) is well documented in patients with cirrhosis, but its effect on survival remains unclear. This cohort study aimed to compare the overall survival between LES-treated patients and untreated patients. We conducted a retrospective cohort study to determine the effect of LES, which is defined as an oral intake of a branched-chain amino acids (BCAA)-enriched nutrient before bedtime, on survival in 523 patients with cirrhosis seen at a tertiary referral center in Japan from March 2004 to April 2019. The association between LES and all-cause mortality was evaluated using propensity score matching and inverse probability of treatment weighting analyses. The median age of the 523 participants was 66 years; 286 (55%) patients were men and 87 (17%) received LES therapy. Of the 231 propensity-matched patients, 20 (26%) LES-treated patients and 72 (47%) untreated patients died during a median follow-up of 2.0 years (interquartile range, 0.5–4.8). Propensity score matching analysis showed that the overall survival was significantly higher in LES-treated patients than in untreated patients (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.34–0.93). The survival benefit of LES therapy was most prominent in patients with Child–Pugh C cirrhosis (HR, 0.40; 95% CI, 0.20–0.81). Inverse probability of treatment weighting analysis also revealed that LES significantly improved the prognosis of patients with cirrhosis (HR, 0.57; 95% CI, 0.33–0.99). In this retrospective study of patients with cirrhosis, we found that nocturnal BCAA supplementation was associated with a significant reduction in the risk of death in patients with liver cirrhosis.

Effects of Branched-Chain Amino Acids on Parameters Evaluating Sarcopenia in Liver Cirrhosis: Systematic Review and Meta-Analysis

“…We excluded six out of these articles with reasons as follows: (1) no clear BCAA group (33,34), (2) abstract without full text ( 35), (3) involving hepatocellular carcinoma (HCC) patients ( 36), ( 4) not involving cirrhosis patients (37), and ( 5) outcome influenced selection (38). Accordingly, the qualitative synthesis included 11 articles, out of which five were included in the quantitative synthesis (38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49).…”

Safety, Tolerability, and Physiological Effects of AXA1665, a Novel Composition of Amino Acids, in Subjects With Child–Pugh A and B Cirrhosis

“…Routine physical activity or late evening snack alone leads to reversal of anabolic resistance, sarcopenia, and improvements in both survival and health-related quality of life parameters in patients with cirrhosis ( 30 , 33 , 59 ). It is, therefore, noteworthy that effects of AXA1665 were demonstrated in the context of SOC.…”

“…When combined with exercise, essential AAs have been shown to increase muscle mass in patients with cirrhosis ( 31 , 32 ). BCAA supplementation in these patients has also demonstrated stimulation of muscle protein synthesis and improved clinical outcomes ( 33 – 37 ). However, provision of BCAAs without additional proteogenic-stimulating essential AAs (eg, histidine, lysine, and threonine) could limit maximal anabolic response in severe catabolic states such as cirrhotic sarcopenia ( 12 , 38 , 39 ).…”

The efficacy of parenteral nutrition (PN) and enteral nutrition (EN) supports in cirrhosis

“…Inverse probability of treatment weighting analysis also revealed that LES significantly improved the prognosis of patients with cirrhosis (HR, 0.57; 95% CI, 0.33-0.99). [ 19 ]…”