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Prospective randomized controlled study of short-term perioperative oral nutrition with branched chain amino acids in patients undergoing liver surgery.
Hepatogastroenterology. 2010 May-Jun; 57(99-100):583-90.H

Abstract

BACKGROUND/AIMS

Early prospective randomized clinical trials demonstrated that perioperative parenteral nutrition (PN) with branched chain amino acids (BCAA) is beneficial in cirrhotic patients with hepatocellular carcinoma who undergo hepatectomy. However, PN support is expensive and requires a long hospital stay. Moreover, PN support has not been evaluated in patients with a normal liver who undergo hepatectomy. It was studied the benefits of perioperative oral nutrition (ON) with BCAA in patients who underwent hepatectomy, including those with a non-hepatitis liver.

METHODOLOGY

In this prospective, randomized, controlled trial, 38 patients were assessed for eligibility. Fourteen patients were excluded because they had received intraoperative blood transfusions or incomplete resections. The 24 eligible patients (20 with malignant liver tumors and 4 with benign liver tumors) were randomly assigned to receive perioperative ON with BCAA (11 patients, BCAA group) or a usual diet (13 patients, control group). The BCAA group received a BCAA supplement twice daily plus a usual diet for 14 days before operation and on days 1 to 7 after operation. The control group received a usual diet alone. The primary end point was the improvement in postoperative biochemical measurements.

RESULTS

Two of the 11 patients in the BCAA group developed postoperative complications, as compared with 3 of the 13 patients in the control group (18.2% vs. 23.1%, p = 0.7686). Serum levels of alanine aminotransferase, aspartate aminotransferase, and ammonia did not differ significantly between the BCAA group and control group; however, peak values were lower in the BCAA group. There was no difference between the groups in serum hemoglobin levels after operation. Among patients with hepatitis, serum erythropoietin (EPO) levels on POD 3, 5, and 7 were slightly but not significantly higher in the BCAA group than in the control group. Among patients with non-hepatitis, serum EPO levels on POD 3, 5, and 7 were significantly higher in the BCAA group than in the control group (p = 0.0174, p = 0.0141, and p = 0.0328, respectively).

CONCLUSION

Short-term ON support with BCAA was associated with higher serum EPO levels than was a normal diet in patients with non-hepatitis who underwent curative hepatic resection. Higher EPO levels might be beneficial in protecting liver cells from ischemic injury and preventing intraoperative hemorrhage associated with lower perioperative levels of alanine aminotransferase and aspartate aminotransferase in serum. This is the first study to demonstrate an effect of EN support with BCAA in patients with non-hepatitis, as well as those with hepatitis.

Authors+Show Affiliations

Department of Surgery, Nippon Medical School, Tokyo, Japan. martinishikawa@nms.ac.jpNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial

Language

eng

PubMed ID

20698232

Citation

Ishikawa, Yoshinori, et al. "Prospective Randomized Controlled Study of Short-term Perioperative Oral Nutrition With Branched Chain Amino Acids in Patients Undergoing Liver Surgery." Hepato-gastroenterology, vol. 57, no. 99-100, 2010, pp. 583-90.
Ishikawa Y, Yoshida H, Mamada Y, et al. Prospective randomized controlled study of short-term perioperative oral nutrition with branched chain amino acids in patients undergoing liver surgery. Hepatogastroenterology. 2010;57(99-100):583-90.
Ishikawa, Y., Yoshida, H., Mamada, Y., Taniai, N., Matsumoto, S., Bando, K., Mizuguchi, Y., Kakinuma, D., Kanda, T., & Tajiri, T. (2010). Prospective randomized controlled study of short-term perioperative oral nutrition with branched chain amino acids in patients undergoing liver surgery. Hepato-gastroenterology, 57(99-100), 583-90.
Ishikawa Y, et al. Prospective Randomized Controlled Study of Short-term Perioperative Oral Nutrition With Branched Chain Amino Acids in Patients Undergoing Liver Surgery. Hepatogastroenterology. 2010;57(99-100):583-90. PubMed PMID: 20698232.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective randomized controlled study of short-term perioperative oral nutrition with branched chain amino acids in patients undergoing liver surgery. AU - Ishikawa,Yoshinori, AU - Yoshida,Hiroshi, AU - Mamada,Yasuhiro, AU - Taniai,Nobuhiko, AU - Matsumoto,Satoshi, AU - Bando,Koichi, AU - Mizuguchi,Yoshiaki, AU - Kakinuma,Daisuke, AU - Kanda,Tomohiro, AU - Tajiri,Takashi, PY - 2010/8/12/entrez PY - 2010/8/12/pubmed PY - 2010/9/9/medline SP - 583 EP - 90 JF - Hepato-gastroenterology JO - Hepatogastroenterology VL - 57 IS - 99-100 N2 - BACKGROUND/AIMS: Early prospective randomized clinical trials demonstrated that perioperative parenteral nutrition (PN) with branched chain amino acids (BCAA) is beneficial in cirrhotic patients with hepatocellular carcinoma who undergo hepatectomy. However, PN support is expensive and requires a long hospital stay. Moreover, PN support has not been evaluated in patients with a normal liver who undergo hepatectomy. It was studied the benefits of perioperative oral nutrition (ON) with BCAA in patients who underwent hepatectomy, including those with a non-hepatitis liver. METHODOLOGY: In this prospective, randomized, controlled trial, 38 patients were assessed for eligibility. Fourteen patients were excluded because they had received intraoperative blood transfusions or incomplete resections. The 24 eligible patients (20 with malignant liver tumors and 4 with benign liver tumors) were randomly assigned to receive perioperative ON with BCAA (11 patients, BCAA group) or a usual diet (13 patients, control group). The BCAA group received a BCAA supplement twice daily plus a usual diet for 14 days before operation and on days 1 to 7 after operation. The control group received a usual diet alone. The primary end point was the improvement in postoperative biochemical measurements. RESULTS: Two of the 11 patients in the BCAA group developed postoperative complications, as compared with 3 of the 13 patients in the control group (18.2% vs. 23.1%, p = 0.7686). Serum levels of alanine aminotransferase, aspartate aminotransferase, and ammonia did not differ significantly between the BCAA group and control group; however, peak values were lower in the BCAA group. There was no difference between the groups in serum hemoglobin levels after operation. Among patients with hepatitis, serum erythropoietin (EPO) levels on POD 3, 5, and 7 were slightly but not significantly higher in the BCAA group than in the control group. Among patients with non-hepatitis, serum EPO levels on POD 3, 5, and 7 were significantly higher in the BCAA group than in the control group (p = 0.0174, p = 0.0141, and p = 0.0328, respectively). CONCLUSION: Short-term ON support with BCAA was associated with higher serum EPO levels than was a normal diet in patients with non-hepatitis who underwent curative hepatic resection. Higher EPO levels might be beneficial in protecting liver cells from ischemic injury and preventing intraoperative hemorrhage associated with lower perioperative levels of alanine aminotransferase and aspartate aminotransferase in serum. This is the first study to demonstrate an effect of EN support with BCAA in patients with non-hepatitis, as well as those with hepatitis. SN - 0172-6390 UR - https://www.unboundmedicine.com/medline/citation/20698232/Prospective_randomized_controlled_study_of_short_term_perioperative_oral_nutrition_with_branched_chain_amino_acids_in_patients_undergoing_liver_surgery_ DB - PRIME DP - Unbound Medicine ER -