Branched-chain amino acids for people with hepatic encephalopathy

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

doi:10.1002/14651858.cd001939.pub4

Cited by 150 publications

(84 citation statements)

References 84 publications

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“…A recent meta-analysis showed that the use of BCAA, which is commonly recommended for treatment of sarcopenia, also had no effect on mortality or nutritional parameters. 30 However, several other studies have provided evidence that BCAA promotes protein synthesis and prevents proteolysis 31 32 and long-term BCAA administration with leucine has been shown to improve prognosis and reduce complications such as sarcopenia in patients with liver cirrhosis. 26 33 34 Therefore, long-term BCAA administration holds promise for reducing muscle loss in cirrhotic patients.…”

Section: Discussionmentioning

confidence: 99%

Presence of Sarcopenia and Its Rate of Change Are Independently Associated with Long-term Mortality in Patients with Liver Cirrhosis

et al. 2018

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BackgroundSarcopenia is associated with a poor prognosis in patients with liver cirrhosis. However, it is not known whether the rate of skeletal muscle depletion is also associated with a poor prognosis. We investigated the prognostic impact of the rate of skeletal muscle depletion in patients with liver cirrhosis.MethodsWe included retrospectively all patients with liver cirrhosis who underwent both multiple computed tomography scans and hepatic venous pressure gradient (HVPG) measurements.ResultsA total of 131 patients with liver cirrhosis were enrolled. The mean age of the patients was 53.7 years and alcoholic liver disease was the most common cause (61.8%). Sixty-four patients (48.9%) were diagnosed with sarcopenia. The median changes in skeletal muscle area per year (ΔSMA/y) were −0.89%. During a median follow-up period of 46.2 months (range, 3.4–87.6), 45 patients (34.4%) died. In multivariate analyses, age, Child-Pugh score, HVPG, presence of sarcopenia and ΔSMA/y were independently associated with mortality. Cumulative mortality was significantly higher in patients with ΔSMA/y < −2.4% than those with ΔSMA/y ≥ −2.4% (log-rank test, P < 0.001).ConclusionBoth the presence and rate of change of sarcopenia are independently associated with long-term mortality in patients with liver cirrhosis.

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Section: Discussionmentioning

confidence: 99%

Presence of Sarcopenia and Its Rate of Change Are Independently Associated with Long-term Mortality in Patients with Liver Cirrhosis

et al. 2018

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“…Moreover, substituting meat with dairy or vegetable proteins along with BCAA supplements is better than reducing total proteins intake[ 117 ]. In a meta-analysis of 16 RCTs, BCAAs were found to have a beneficial effect on HE compared to placebo or best supportive care (diet, lactulose, or neomycin), however, no conclusions could be drawn regarding nutritional effects[ 133 ]. General nutritional recommendations in the cirrhotic patients with obesity are summarized in Table 2 .…”

Section: Protein and Calorie Intake In Patients With Obesity And Cirrmentioning

confidence: 99%

Nutritional issues in patients with obesity and cirrhosis

Schiavo¹,

Busetto²,

Cesaretti³

et al. 2018

WJG

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Obesity and metabolic syndrome are considered as responsible for a condition known as the non-alcoholic fatty liver disease that goes from simple accumulation of triglycerides to hepatic inflammation and may progress to cirrhosis. Patients with obesity also have an increased risk of primary liver malignancies and increased body mass index is a predictor of decompensation of liver cirrhosis. Sarcopenic obesity confers a risk of physical impairment and disability that is significantly higher than the risk induced by each of the two conditions alone as it has been shown to be an independent risk factor for chronic liver disease in patients with obesity and a prognostic negative marker for the evolution of liver cirrhosis and the results of liver transplantation. Cirrhotic patients with obesity are at high risk for depletion of various fat-soluble, water-soluble vitamins and trace elements and should be supplemented appropriately. Diet, physical activity and protein intake should be carefully monitored in these fragile patients according to recent recommendations. Bariatric surgery is sporadically used in patients with morbid obesity and cirrhosis also in the setting of liver transplantation. The risk of sarcopenia, micronutrient status, and the recommended supplementation in patients with obesity and cirrhosis are discussed in this review. Furthermore, the indications and contraindications of bariatric surgery-induced weight loss in the cirrhotic patient with obesity are discussed.

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“…A meta-analysis[178] performed on nine RCTs demonstrated a significant improvement in the grade of HE with the administration of oral BCAAs compared to other nutritional supplements, but no difference was found in terms of resolution of HE. Another recent Cochrane meta-analysis on 16 RCTs indicated that oral administration of BCAAs had a beneficial impact on HE, without effect on mortality, quality of life, and nutritional status[179]. Considering prophylaxis of HE, several studies showed that oral BCAAs do not prevent development or recurrence of HE in cirrhotic patients[180-182].…”

Section: Dietary Approachmentioning

confidence: 99%

Dietary approach and gut microbiota modulation for chronic hepatic encephalopathy in cirrhosis

Campion¹,

Giovo²,

Ponzo³

et al. 2019

WJH

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Hepatic encephalopathy (HE) is a common and serious neuropsychiatric complication of cirrhosis, acute liver failure, and porto-systemic shunting. HE largely contributes to the morbidity of patients with liver disease, severely affecting the quality of life of both patients and their relatives and being associated with poor prognosis. Its presentation is largely variable, manifesting with a broad spectrum of cognitive abnormalities ranging from subtle cognitive impairment to coma. The pathogenesis of HE is complex and has historically been linked with hyperammonemia. However, in the last years, it has become evident that the interplay of multiple actors, such as intestinal dysbiosis, gut hyperpermeability, and neuroinflammation, is of crucial importance in its genesis. Therefore, HE can be considered a result of a dysregulated gut-liver-brain axis function, where cognitive impairment can be reversed or prevented by the beneficial effects induced by “gut-centric” therapies, such as non-absorbable disaccharides, non-absorbable antibiotics, probiotics, prebiotics, and fecal microbiota transplantation. In this context dietary modifications, by modulating the intestinal milieu, can also provide significant benefit to cirrhotic patients with HE. This review will provide a comprehensive insight into the mechanisms responsible for gut-liver-brain axis dysregulation leading to HE in cirrhosis. Furthermore, it will explore the currently available therapies and the most promising future treatments for the management of patients with HE, with a special focus on the dietary approach.

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Branched-chain amino acids for people with hepatic encephalopathy

Abstract: Branched-chain amino acids for people with hepatic encephalopathy (Review)

Cited by 150 publications

References 84 publications

Presence of Sarcopenia and Its Rate of Change Are Independently Associated with Long-term Mortality in Patients with Liver Cirrhosis

Presence of Sarcopenia and Its Rate of Change Are Independently Associated with Long-term Mortality in Patients with Liver Cirrhosis

Nutritional issues in patients with obesity and cirrhosis

Dietary approach and gut microbiota modulation for chronic hepatic encephalopathy in cirrhosis

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