Protein supplementation may be beneficial for patients with chronic liver disease (CLD). This study compared the effects of whey protein isolate (WP) and casein (CA) supplementation on nutritional status and immune parameters of CLD patients who were randomly assigned to take 20 g of WP or CA twice a day as a supplement for 15 days. Body composition, muscle functionality and plasmatic immunomarkers were assessed before and after supplementation. Patients were also classified according to the model for end-stage liver disease (MELD) into less (MELD <15) and more (MELD≥15) more severe disease groups. Malnutrition, determined by the Subjective Global Assessment at baseline, was observed in 57.4% and 54.2% of patients in the WP and CA groups, respectively (p=0.649). Protein intake was lower at baseline in the WP group than in the CA group (p=0.035), with no difference after supplementation (p=0.410). Both the WP and CA MELD<15 groups increased protein intake after supplementation according to intragroup analysis. No differences were observed in body composition, muscle functionality, most plasma cytokines (TNF, IL-6, IL-1β and IFN-γ), immunomodulatory proteins (sTNFR1, sTNFR2, BDNF and GDNF), or immunomodulatory hormones (adiponectin, insulin, and leptin) after supplementation in the WP groups at the two assessed moments. WP supplementation increased the levels of IP-10/CXCL10 (p=0.022), eotaxin-1/CCL11 (p=0.031) and MCP-1/CCL2 (p=0.018) and decreased IL-5 (p=0.027), including among those in the MELD≥15 group, for whom IL-10 was also increased (p=0.008). Thus, WP consumption by patients with CLD impacted the immunomodulatory responses when compared to CA with no impact on nutritional status.

Background & aims: Chronic liver disease is associated with malnutrition that negatively impacts a patient’s health-related quality of life (HRQoL). We evaluated the short-term effect of whey protein supplementation on the HRQoL and nutritional and functional status of patients waiting for liver transplantation (LT). Methods: This was a double-blind randomized clinical trial with patients waiting for LT who were randomized into two groups: WP (whey protein supplementation) and the control (casein supplementation). Both groups received 40g (20g in the morning and 20 g in the evening) for 15 days. Nutritional and functional status were evaluated. Energy balance (EB) was calculated as the difference between energy intake (24-hour recall) and total energy expenditure. The chronic liver disease questionnaire (CLDQ) was used to assess HRQoL. All measurements were performed before and after the intervention. Results: Fifty-six patients were evaluated. Malnutrition was present in 56.9% of patients, and it was directly associated with a poor HRQoL (p<0.05). No improvement on the nutritional and functional status was observed, in either group after protein supplementation. HRQoL improved after WP and casein supplementation, with no differences between groups (p>0.05). Patients who met protein requirements and had a positive EB demonstrated a higher HRQoL score (4.9) (p<0.05), without between-group differences. Conclusion: Malnutrition substantially reduces HRQoL. Short-term WP or casein supplementation improved the HRQoL.

Background: Chronic liver disease is associated with malnutrition that negatively impacts a patient’s health-related quality of life (HRQoL). Aim: To evaluate the short-term effect of whey protein supplementation on the HRQoL and nutritional and functional status of patients waiting for liver transplantation. Methods: This was a double-blind randomized clinical trial with patients waiting for liver transplantation who were randomized into two groups: WP (whey protein supplementation) and the control (casein supplementation). Both groups received 40 g (20 g in the morning and 20 g in the evening) for 15 days. Nutritional and functional status were evaluated. Energy balance was calculated as the difference between energy intake (24-hour recall) and total energy expenditure (assessed by indirect calorimetry). The chronic liver disease questionnaire was used to assess HRQoL. All measurements were performed before and after the intervention. Results: Fifty-six patients were evaluated. Malnutrition was present in 56.9%, and it was directly associated with a poor HRQoL (p<0.05). No improvement on the nutritional and functional status was observed, in either group after protein supplementation. HRQoL improved after WP and casein supplementation, with no differences between groups (p>0.05). Patients who met protein requirements and had a positive energy balance demonstrated a higher HRQoL score (4.9, p<0.05), without between-group differences. Conclusion: Malnutrition substantially reduces HRQoL. Short-term WP or casein supplementation improved similarly the HRQoL.

Background Abdominal obesity (AO) is linked to reduced health status and mortality. While it is known that AO is prevalent in chronic obstructive pulmonary disease (AO-COPD), the specific metabolic and functional consequences associated with AO-COPD remain understudied. Methods We studied 199 older adults with COPD and 168 control subjects with and without AO and assessed visceral adipose tissue (VAT) by dual-energy X-ray absorptiometry. VAT > 70th percentile of the control group qualified a subject as AO in a sex specific manner. We measured plasma concentrations and whole body production (WBP) rates of multiple amino acids to assess the metabolic profile. We assessed medical history, body composition by Dual-Energy X-ray Absorptiometry, muscle strength, and cognitive function. We performed statistics by analysis of covariance (p) and FDR (q) for multiple comparisons. Results AO-COPD subjects had 27% more VAT (q < 0.01) than AO-Control subjects despite correction for BMI. Branched-chain amino acid concentrations and WBP rates were generally elevated in AO-COPD but whole body clearance rate was only elevated in COPD. Metabolic syndrome comorbidities (p < 0.01) and systemic inflammation (P < 0.05) were most prevalent in the AO-COPD group. Muscle strength was reduced in COPD subjects (p < 0.001), but partially preserved when combined with AO. Cognitive dysfunction and mood disturbances were present in COPD subjects (p < 0.001) with worst performers in AO-COPD (q < 0.05). Conclusion The presence of AO is associated with specific metabolic and functional phenotypes in COPD. Clinical trial registry Trial registration ClinicalTrials.gov. In the present paper, we report an analysis of the baseline measurements of COPD subjects and healthy controls from the study numbers: NCT01787682, NCT01787682, NCT02157844, NCT02082418, NCT02065141, NCT02770092, NCT02908425, NCT03159390, NCT02780219, NCT03327181, NCT03796455, NCT04928872, NCT04461236, NCT01173354, NCT01154400.

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