Branched-chain amino acid enriched supplements as therapy for liver disease

Michael Charlton

Research output: Contribution to journalArticle

116 Citations (Scopus)

Abstract

Altered amino acid metabolism is a hallmark of liver disease, characterized by low levels of circulating BCAAs and elevated levels of circulating aromatic amino acids, and methionine. Although overwhelming evidence indicates that the incidence of complications of liver disease increases with malnutrition, the reported impact of nutritional therapy, specifically BCAA supplementation, on outcomes in patients with liver disease has varied with the indication. Multiple small studies report the beneficial effects of BCAA supplementation, including improved metabolic profiles, as measured by protein sparing and/or normalization of respiratory quotients and clinical improvement of hepatic encephalopathy. Other studies have failed to show a clinical benefit of BCAA supplementation. The data concerning the impact of BCAA supplementation in prophylaxis of long-term morbidity and mortality in patients with cirrhosis is more promising and has been the subject of 2, large randomized controlled trials. In a study of 174 patients with advanced cirrhosis, who were randomized to either BCAA or 1 of 2 control arms, the combined event rates were seen to be significantly reduced in the BCAA supplementation arm, although this was not true for individual complications. In a more recent, larger, randomized controlled trial (n = 646) using a more palatable formulation, investigators demonstrated that long-term BCAA supplementation is associated with decreased frequency of hepatic failure and overall complication frequency. Both studies found improved nutritional status associated with BCAA supplementation. On balance, BCAA supplementation appears to be associated with decreased frequency of complications of cirrhosis and improved nutritional status when prescribed as maintenance therapy. Cost and palatability may limit the potential applicability of this treatment modality.

Original languageEnglish (US)
JournalJournal of Nutrition
Volume136
Issue number1
StatePublished - Jan 2006

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Branched Chain Amino Acids
branched chain amino acids
liver diseases
Liver Diseases
Fibrosis
Nutritional Status
therapeutics
nutritional status
Randomized Controlled Trials
liver failure
Aromatic Amino Acids
diet therapy
respiratory quotient
encephalopathy
Metabolome
Hepatic Encephalopathy
amino acid metabolism
Liver Failure
palatability
Malnutrition

Keywords

  • Branched-chain amino acids
  • Liver disease

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Food Science

Cite this

Branched-chain amino acid enriched supplements as therapy for liver disease. / Charlton, Michael.

In: Journal of Nutrition, Vol. 136, No. 1, 01.2006.

Research output: Contribution to journalArticle

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