Enriched Branched‐Chain Amino Acid Formula Versus a Casein‐Based Supplement in the Treatment of Cirrhosis

Christie, Mary L.; Sack, David M.; Pomposelli, James J.; Horst, Douglas

doi:10.1177/0148607185009006671

Cited by 70 publications

(29 citation statements)

References 31 publications

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“…Since the 1970's, multiple studies have been done that have proven that protein restriction is not beneficial in HE; a summary of these studies can be found in table 1 [24,[36][37][38][39][40][41][42][43][44][45] . As far back as 1977,…”

Section: Effects Of Protein Restrictions On Progression Of Liver Diseasementioning

confidence: 99%

“…Compared to control groups consuming 40 g of protein, the higher intake of protein did not result in increased progression of liver failure or incidence Iiames J et al . Protein in older cirrhotic adults of HE [37][38][39][40] . Similar studies continued in the 1990's, showing that higher amounts of protein intake do not lead to worsening of hepatic encephalopathy [41,42,45] .…”

Section: Effects Of Protein Restrictions On Progression Of Liver Diseasementioning

confidence: 99%

“…Protein in older cirrhotic adults Table 1 Summary of studies examining safety of increased protein intake in liver disease. Author, Year Greenberger et al [36] Keshavarian et al [37] 1984 Christie et al [38] Bunout D et al [39] 1989 Swart GR et al [40] 1989 Cabre E et al [45] 1990 Bianchi et al [41] 1993 Kearns et al [24] 1995 Nielsen et al [42] 1995 Cordoba et al [43] [57] 2000 Yamauchi et al [75] 2001 YamanakaOkumura et al [68] 2006 Fukushima et al [72] 2003 Sako et al [73] 2003 Nakaya et al [74] 2007 YamanakaOkumura et al [76] …”

Section: Branched Chain Amino Acid Supplementation In Older Adults Wimentioning

confidence: 99%

“…Of the 9 studies completed to date, 7 showed improvements in nitrogen balance, ratio of branched chain to aromatic amino acids, serum albumin, fuel metabolism, quality of life scores, liver function, muscle mass, and survival, as well as decreases in serum ketone bodies and muscle cramps [72][73][74][75][83][84][85] . Two of the studies showed no significant differences between the treatment group and the control group [38,82] ; however, they both included very small sample sizes.Additionally, one of the studies that showed no difference had a baseline diet of only 40 g protein/day, suggesting that increased protein of any kind is beneficial whether it comes from BCAA or casein. Similar to the reviews previously completed, it is difficult to draw strong conclusions due to the fact that several of the studies had limitations including small sample sizes, short study durations, different study protocols, and varying outcome measures.…”

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confidence: 99%

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Protein Recommendations for Older Adults with Cirrhosis: A Review

Iiames

Logomarsino

2015

Journal of Gastroenterology and Hepatology Research

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Protein intake has a key role in liver cirrhosis in older adults. However, types and amounts of protein intake in cirrhosis have been controversial. The aim of this paper is to investigate the optimal protein intake for management of cirrhosis and prevention of hepatic encephalopathy in older adults. Protein restriction of 0.6 g/kg/d has traditionally been used as medical nutrition therapy in liver cirrhosis. However, recent evidence has shown that protein restrictions have many negative consequences for older adults with cirrhosis. Current research indicates protein intakes of 1.2-1.5 g/ kg/d in liver cirrhosis; however, many older adults do not consume this amount. Strategies to help increase protein intake and manage cirrhosis include ensuring adequate protein at every meal through either regular intake or supplementation, protein supplementation prior to bedtime or overnight, and supplementation with branchedchain amino acids. An emphasis on vegetable protein versus animal protein is probably not an advantageous treatment option because of lack of conclusive evidence regarding benefits and potential negative side effects. and progression of chronic liver disease and cirrhosis.There are several different factors that naturally occur in older adulthood that help contribute to the development of chronic liver disease and cirrhosis. After reaching maximum size in early adulthood, the liver steadily decreases in both size and the amount of blood flow it receives, leading to decreased function and efficiency over time [10] . Also, increased ammonia production and bacterial overgrowth are common in older adulthood, both of which are thought to play a key role in development of hepatic encephalopathy [11] . Older adults tend to have chronic constipation, intestinal dysmotility, and increased colonic transit time, which predisposes them to increased ammonia production [12] . Finally, older adulthood is associated with a higher incidence of diabetes, which is strongly correlated to progression of liver cirrhosis [13] . Pathogenesis of malnutrition in older adults with cirrhosisIt is estimated that 20% of patients with compensated cirrhosis and 60% of patients with decompensated cirrhosis have malnutrition [14] . In older adults, protein energy malnutrition is associated with high health care costs, increased frequency of infection and bedsores, increased morbidity and mortality, and poor physical functioning [4,5] . In canine trials, poor nutritional status has been shown to encourage the development of hepatic encephalopathy [15] . In addition, malnutrition in cirrhosis is positively associated with old age [14] . Multiple factors help contribute to the development of malnutrition in older adults with cirrhosis, including inadequate intake, altered absorption, sarcopenia, and altered metabolism. All causes must be explored and taken into consideration when developing treatment and prevention strategies.In older adults, food intake naturally decreases over time [16] , which promotes the development of malnutri...

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Section: Effects Of Protein Restrictions On Progression Of Liver Diseasementioning

confidence: 99%

Section: Effects Of Protein Restrictions On Progression Of Liver Diseasementioning

confidence: 99%

Section: Branched Chain Amino Acid Supplementation In Older Adults Wimentioning

confidence: 99%

mentioning

confidence: 99%

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Protein Recommendations for Older Adults with Cirrhosis: A Review

Iiames

Logomarsino

2015

Journal of Gastroenterology and Hepatology Research

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“…120 (c) In patients with frank encephalopathy, two crossover trials could not demonstrate that such individuals tolerated increasing amounts of BCAAs any better than other nitrogen sources. 118,119 (d) In patients with latent encephalopathy, one group 110 and one crossover 115 study showed better tolerance for the increasing amounts of BCAAs, but this ®nding could not be duplicated in one other group 113 and four crossover 117,118,121,122 experiments. Hence, it is dif®cult at this time to support the use of oral BCAAs in patients with liver disease.…”

Section: ±107mentioning

confidence: 99%

Nutritional support

Ofman

Koretz

1997

Aliment Pharmacol Ther

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Nutritional support currently accounts for about 1% of the total health care costs in the USA. Interestingly, most of the prospective randomized controlled trials to date have not been able to demonstrate that this therapeutic intervention alters morbidity or mortality. In fact, parenteral nutritional support may predispose the recipients to developing systemic infections. There have been a few areas in which nutritional support may be of benefit. Enteral supplements given to underweight women who suffer hip fractures reduce the hospital stay and, presumably, overall cost. Preoper‐ative parenteral nutritional support may produce a small absolute reduction in post‐operative morbidity, but its cost becomes prohibitive. Preoperative enteral nutritional support, especially if carried out in the home, may be of benefit (using the most optimistic interpretation of a small number of trials); if so, it is an economically defensible intervention. Particular nutrients or diets may have specific effects on certain disease processes. Indirect comparisons have suggested that elemental diets can be used to treat flares of Crohn's disease (perhaps because putative food antigens are removed). However, corticosteroid therapy is more efficacious. Furthermore, it is less expensive to employ 6‐mercaptopurine as the next modality in steroid failures. Branched‐chain amino acid infusions may have some effect on hepatic encephalopathy, but again, lactulose is less expensive. Nutritional support is one area of medicine in which there has been far more enthusiasm than the data justify. Disease‐associated malnutrition probably is a secondary phenomenon, not an important cause of morbidity. The widespread use of this modality cannot be justified in a cost‐constrained health care system.

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