Standard or Branched‐Chain Amino Acid Infusions as Short‐Term Nutritional Support in Liver Cirrhosis?

Abstract

The metabolic effects of selected and branched-chain amino acid (BCAA)-enriched parenteral solutions were studied in liver cirrhosis. After 3 days of an oral protein-free diet with balanced amino acid (AA) infusion, 36 cirrhotic patients without encephalopathy were randomly divided into four groups. Groups A and B were infused for 5 days with BCAA (valine, leucine, isoleucine) at doses of 0.5 and 1.0 g/kg/day, respectively, as the only nitrogen source. Group C received 0.8 g/kg of essential and nonessential AA solution with a prevalence of BCAA; the last group (D) continued the basic standard diet, as control. Routine chemistry, urinary nitrogen losses, nitrogen balance, and the whole plasma AA pattern were detected before and after the treatment period. BCAA alone led to an impressive and significant improvement in the basic AA pattern in both the A and B groups. The same results were obtained in group C for plasma AA. In particular, the ratio of BCAA to aromatic amino acids in groups A, B, and C was significantly increased (p less than 0.01, less than 0.02, less than 0.02, respectively). In group D the AA pattern and the BCAA/aromatic amino acid ratio remained unchanged. The negative nitrogen balance of the base state remained unchanged after 0.5 g of BCAA (A); it improved significantly and became positive during and after the infusions of a double dose of BCAA (B), as it did in the case of selective solutions (C), although to a lesser extent; the negative nitrogen balance of the control group showed only a slight improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Zinc and magnesium in liver cirrhosis

“…The present results point to a severe impairment of protein carriers due to nitrogen catabolism derangement as the leading factor in trace-element imbalance in liver cirrhosis, whether of alcoholic aetiology or not. Negative nitrogen balance is a common feature of liver cirrhosis, albeit compensated, as previous studies from our group have clearly documented [2].…”

“…As regards Mg, various factors may account for its reduction: hormonal imbalance with decreased renal tubular reabsorption, hyperaldosteronism and peripheral insulino-resistance are well documented in cirrhotic patients [32,33]; as a consequence, protein turnover imbalance and hypercatabolic conditions which invariably follow [2] may contribute to Mg depletion through the increased loss of aminoacids and urea nitrogen. The present results point to a severe impairment of protein carriers due to nitrogen catabolism derangement as the leading factor in trace-element imbalance in liver cirrhosis, whether of alcoholic aetiology or not.…”

“…Any assessment of the condition of a patient suffering from chronic liver disease must take nutritional factors into account if a correct therapeutic approach is to be adopted [1,2,3].…”

“…Chronic liver patients, and particularly those suffering from cirrhosis, always have a negative proteincalorie balance, even if more serious complications are absent [2]. Also, liposoiuble vitamin levels are almost halved in the plasma ofcirrhotic patients without there Correspondence being necessarily any evidence of significant malnutrition or other complications [4].…”

Consilience in sarcopenia of cirrhosis

“…When branched chain amino acids are administered, stimulation of protein synthesis by leucine is likely to result in increased utilization of other essential amino acids that may then become limiting for protein synthesis. Even though this has not been specifically evaluated in patients with cirrhosis, the alteration in plasma amino acid profile in response to branched chain versus balanced amino acids lends credence to this view [127]. This can be overcome by administering a balanced mixture of essential amino acids with leucine enrichment.…”