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Effects of branched-chain amino acids supplementation in patients with cirrhosis and a previous episode of hepatic encephalopathy: a randomized study.
Am J Gastroenterol 2011; 106(6):1081-8AJ

Abstract

OBJECTIVES

Protein intake impacts on nutritional status and may determine the recurrence of hepatic encephalopathy (HE). A low-protein diet has been considered the standard treatment after an episode of HE, while branched-chain amino acids (BCAA) have been shown to improve minimal HE. We performed a study to investigate the long-term effects of supplementing a protein-controlled diet with BCAA.

METHODS

A randomized, double-blind, multicenter study that included 116 patients with cirrhosis and a previous episode of HE was conducted in four tertiary care hospitals. All patients received a standard diet of 35 kcal/kg per day and 0.7 g of proteins/kg per day and a supplement of 30 g of BCAA (BCAA group) or maltodextrin (MDX group) during 56 weeks.

RESULTS

The actuarial risk of remaining free of HE did not differ between groups (BCAA=47%, MDX=34%, P=0.274), but patients in the BCAA group exhibited a better outcome on two neuropsychological tests and an increase in the mid-arm muscle circumference. Recurrence was associated with low plasma albumin at baseline and a decrease in sodium and an increase in creatinine during follow-up. Patients with recurrence of HE exhibited a lack of improvement in global cognitive function.

CONCLUSIONS

Diet supplementation with BCAA after an episode of HE does not decrease recurrence of HE. However, supplementation with BCAA improves minimal HE and muscle mass. Identification of risk factors for recurrence of HE may allow the development of new preventive therapies that could decrease the neuropsychological sequelae of repeated episodes of HE.

Authors+Show Affiliations

Servei de Medicina Interna-Hepatologia, Hospital Vall d'Hebron, Barcelona, Spain.No 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 availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

21326220

Citation

Les, Iñigo, et al. "Effects of Branched-chain Amino Acids Supplementation in Patients With Cirrhosis and a Previous Episode of Hepatic Encephalopathy: a Randomized Study." The American Journal of Gastroenterology, vol. 106, no. 6, 2011, pp. 1081-8.
Les I, Doval E, García-Martínez R, et al. Effects of branched-chain amino acids supplementation in patients with cirrhosis and a previous episode of hepatic encephalopathy: a randomized study. Am J Gastroenterol. 2011;106(6):1081-8.
Les, I., Doval, E., García-Martínez, R., Planas, M., Cárdenas, G., Gómez, P., ... Córdoba, J. (2011). Effects of branched-chain amino acids supplementation in patients with cirrhosis and a previous episode of hepatic encephalopathy: a randomized study. The American Journal of Gastroenterology, 106(6), pp. 1081-8. doi:10.1038/ajg.2011.9.
Les I, et al. Effects of Branched-chain Amino Acids Supplementation in Patients With Cirrhosis and a Previous Episode of Hepatic Encephalopathy: a Randomized Study. Am J Gastroenterol. 2011;106(6):1081-8. PubMed PMID: 21326220.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effects of branched-chain amino acids supplementation in patients with cirrhosis and a previous episode of hepatic encephalopathy: a randomized study. AU - Les,Iñigo, AU - Doval,Eduardo, AU - García-Martínez,Rita, AU - Planas,Mercè, AU - Cárdenas,Guillermo, AU - Gómez,Pilar, AU - Flavià,Montse, AU - Jacas,Carlos, AU - Mínguez,Beatriz, AU - Vergara,Mercedes, AU - Soriano,Germán, AU - Vila,Carmen, AU - Esteban,Rafael, AU - Córdoba,Juan, Y1 - 2011/02/15/ PY - 2011/2/18/entrez PY - 2011/2/18/pubmed PY - 2011/8/13/medline SP - 1081 EP - 8 JF - The American journal of gastroenterology JO - Am. J. Gastroenterol. VL - 106 IS - 6 N2 - OBJECTIVES: Protein intake impacts on nutritional status and may determine the recurrence of hepatic encephalopathy (HE). A low-protein diet has been considered the standard treatment after an episode of HE, while branched-chain amino acids (BCAA) have been shown to improve minimal HE. We performed a study to investigate the long-term effects of supplementing a protein-controlled diet with BCAA. METHODS: A randomized, double-blind, multicenter study that included 116 patients with cirrhosis and a previous episode of HE was conducted in four tertiary care hospitals. All patients received a standard diet of 35 kcal/kg per day and 0.7 g of proteins/kg per day and a supplement of 30 g of BCAA (BCAA group) or maltodextrin (MDX group) during 56 weeks. RESULTS: The actuarial risk of remaining free of HE did not differ between groups (BCAA=47%, MDX=34%, P=0.274), but patients in the BCAA group exhibited a better outcome on two neuropsychological tests and an increase in the mid-arm muscle circumference. Recurrence was associated with low plasma albumin at baseline and a decrease in sodium and an increase in creatinine during follow-up. Patients with recurrence of HE exhibited a lack of improvement in global cognitive function. CONCLUSIONS: Diet supplementation with BCAA after an episode of HE does not decrease recurrence of HE. However, supplementation with BCAA improves minimal HE and muscle mass. Identification of risk factors for recurrence of HE may allow the development of new preventive therapies that could decrease the neuropsychological sequelae of repeated episodes of HE. SN - 1572-0241 UR - https://www.unboundmedicine.com/medline/citation/21326220/Effects_of_branched_chain_amino_acids_supplementation_in_patients_with_cirrhosis_and_a_previous_episode_of_hepatic_encephalopathy:_a_randomized_study_ L2 - http://Insights.ovid.com/pubmed?pmid=21326220 DB - PRIME DP - Unbound Medicine ER -