Branched-chain amino acids for people with hepatic encephalopathy

Gluud, Lise Lotte; Dam, Gitte; Les, Íñigo; Córdoba, Juan; Marchesini, Giulio; Borre, Mette; Aagaard, Niels Kristian; Vilstrup, Hendrik

doi:10.1002/14651858.cd001939.pub2

Cited by 63 publications

(47 citation statements)

References 81 publications

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“…It has evaluated whether BCAA benefit patients with cirrhosis of liver suffering from HE. 8 16 randomized clinical trials including 827 participants with hepatic encephalopathy classified as overt HE (12 trials) or minimal HE (four trials). Eight trials assessed the effectiveness of oral BCAA supplements and seven trials assessed the role of intravenous BCAA.…”

Section: Discussionmentioning

confidence: 99%

“…BCAA proved to have a beneficial effect in the treatment of hepatic encephalopathy (RR 0.73, 95% CI 0.61 to 0.88;). 8 The analyses showed that BCAA had a useful role in the treatment of hepatic encephalopathy. In a study conducted in Peswahar, it was found that After the administration of BCAA infusion twice daily for 3 days, clinical improvement was observed in 33 (76.7%) patients in group taking infusion of BCCA while in group taking placebo only 10 (23.3%) patients improved clinically, showing p-value 0.001.…”

Section: Discussionmentioning

confidence: 99%

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Role of Branched Chain Amino Acids in Hepatic Encephalopathy

Ahmed¹,

Shaukat²,

Aamir³

et al. 2017

APMC

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Introduction: Hepatic encephalopathy (HE) or portosystemic encephalopathy is a state characterized by disordered central nervous system functions because of failure of liver to detoxify nitrogenous agents originating from gut because of dysfunction of hepatocytes and portosystemic shunting. Patients with HE often present alteration of mental status varying from minor psychological abnormalities to deep coma. Multiple studies conducted worldwide suggest that the branchedchain amino acids (BCAAs) leucine, isoleucine, and valine may be useful in improving survival and reducing morbidity in patients with HE. Objectives: To compare the efficacy of branched chain amino acids in reversal of hepatic encephalopathy in patients with cirrhosis of liver with placebo. Study Design: Randomized control trial Setting: Medical Unit V, DHQ Hospital Faisalabad Duration: Study was carried out over a period of 6 months from 1 st July 2016 to 30 December 2016 Results: A total of 60 patients (30 in each group) were enrolled, majority of the patients were between 41-50 years in both groups, 36.67% (n=11) in Study and 43.33% (n=13) control group, mean and standard deviation of age was calculated as 43.56+5.21 in study and 45.78+4.98 years in control group, 70% (n=21)patients were male in study group and 63.33% (n=19) in the control group, 30% (n=9) patients in study group and 36.67% (n=11) in control group were females, comparison of efficacy of BCAAs in reversal of HE with placebo reveals 63.33% (n=19) patients in study group showed reversal of HE and 26.67% (n=8) patients in control group. Conclusion: The results of the study conclude that branched chain amino acids are significantly effective in reversal of hepatic encephalopathy when compared with placebo.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Role of Branched Chain Amino Acids in Hepatic Encephalopathy

Ahmed¹,

Shaukat²,

Aamir³

et al. 2017

APMC

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“…It may inhibit hepatic carcinogenesis in patients with compensated cirrhosis with a serum albumin level of less than 4.0 g/dL [11]. A recent meta-analysis [211] involving eight trials of orally administered BCAA supplements and seven trials of intravenously administered BCAAs concluded that BCAAs had a beneficial effect on hepatic encephalopathy, although we need additional randomized clinical trials to determine the effect of BCAAs compared with interventions such as nonabsorbable disaccharides, rifaximin, or other antibiotics.…”

Section: Cq: Is Albumin Infusion Effective For Treatment Of Cirrhoticmentioning

confidence: 99%

Evidence-based clinical practice guidelines for liver cirrhosis 2015

et al. 2016

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The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V 2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for patients with acute-onset or progressive portal vein thrombosis.

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“…En niños la administración de suplementos orales no ha mostrado beneficios claros (55). En adultos, una reciente revisión Cochrane, que incluye siete ensayos clínicos que evalúan la administración intravenosa de BCAA en pacientes con encefalopatía hepática, muestra beneficios sobre la evolución clínica de la encefalopatía, aunque no encuentra diferencias en la mortalidad, calidad de vida o parámetros nutricionales (56). Es importante tener en cuenta que las fórmulas pediátricas para NP contienen una mayor cantidad de BCAA que las de adultos.…”

Section: Modificaciones En El Diseño Del Preparado De Npunclassified

Nutrición parenteral en situaciones clínicas especiales

Martínez¹,

Giner

2017

Nutr Hosp

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RECIÉN NACIDO PREMATUROLa nutrición parenteral (NP) constituye un pilar fundamental en la nutrición del recién nacido (RN) prematuro, especialmente en el RN muy prematuro (< 32 semanas de gestación) y RN prematuro extremo (< 28 semanas de gestación) (1). En estos pacientes, la administración de una NP balanceada y precoz se considera de elección (2). Dos metaanálisis han demostrado que la NP precoz en el RN prematuro < 1.500 g es segura, sin aumentar el riesgo de efectos adversos (3,4), y ha mostrado beneficios en relación con un balance nitrogenado positivo (ver aporte proteico) y mayor ganancia ponderal respecto a controles, aunque no se ha observado mayor longitud o perímetro craneal al alta en el grupo de intervención (3). Cabe destacar que los ensayos clínicos analizados cuentan con pequeño tamaño muestral y son heterogéneos (3,4). NECESIDADES ENERGÉTICASLa evidencia sobre las necesidades energéticas del RN prematuro es muy escasa, pues desde una aproximación empírica es muy difícil desligar el efecto de la energía administrada del obtenido por el aporte proteico y resto de nutrientes. Por tanto, las recomendaciones energéticas del RN prematuro se basan en el método factorial, asumiendo que su composición corporal es similar a la del feto y que el crecimiento debería ser similar al que ocurre intraútero (5). Actualmente, se recomienda un aporte inicial de 60 kcal/kg/día, con aumento rápido y progresivo hasta las 90-100 kcal/kg/día en la primera semana (1). Posteriormente se irá incrementado en función del peso de RN (2,6), con el objetivo de conseguir un crecimiento lo más próximo al crecimiento fetal (ver capítulo de "Requerimientos en nutrición parenteral pediátrica" en las tablas II y III). MODIFICACIONES EN EL DISEÑO DEL PREPARADO DE NP Requerimientos proteicosEl aporte proteico mínimo para conseguir un balance nitrogenado positivo en el RN prematuro es 1,5 g/kg/día (6). No obstante, en los últimos años se ha demostrado seguro el aporte inicial de 2,4 g/kg/ día el primer día de vida (4,7,8). Los resultados dependen no solo de la dosis de aminoácidos (AA) sino del aporte concomitante de calorías no proteicas. Así, en el RN prematuro < 1.500 g el aporte proteico inicial de 2,4 g/kg/día junto a lípidos (2 g/kg/día el primer día, incrementando a 3 g/kg/día el segundo) mejoró el balance nitrogenado respecto al mismo aporte proteico sin lípidos (7). Aportes iniciales superiores (3,6 g/kg/día junto a lípidos) no han demostrado mejorar el balance nitrogenado y se asocian a aumento de urea plasmática que refleja una mayor oxidación de AA (7,9). En un reciente ensayo clínico con RN prematuros < 1.500 g se demostró mayor síntesis de albúmina en 12 pacientes con aporte precoz proteico de 3,6 g/ kg/día junto a lípidos comparados con 9 pacientes que recibieron 2,4 g/kg/día junto a lípidos (8), datos que deben ser refrendados en estudios de mayor tamaño muestral (ver capítulo de "Requerimientos en nutrición parenteral pediátrica" para incrementos posteriores).La fórmula de AA a administrar debe contener cisteína, tiro...

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Branched-chain amino acids for people with hepatic encephalopathy

Abstract: Branched-chain amino acids for people with hepatic encephalopathy.

Cited by 63 publications

References 81 publications

Role of Branched Chain Amino Acids in Hepatic Encephalopathy

Role of Branched Chain Amino Acids in Hepatic Encephalopathy

Evidence-based clinical practice guidelines for liver cirrhosis 2015

Nutrición parenteral en situaciones clínicas especiales

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