Evaluating response to nutritional therapy using the branched-chain amino acid/tyrosine ratio in patients with chronic liver disease

Abstract

The branched-chain amino acid (BCAA)/ tyrosine (Tyr) ratio (BTR) recently has been reported to be a good indicator of the severity of hepatic parenchymal injury in patients with chronic liver disease. In the present study, sequential changes of BTR after BCAA administration were determined in patients with chronic liver disease to evaluate the value of BTR as a marker of the clinical response to nutritional therapy in these patients. This study comprised 75 patients with chronic hepatitis and 96 with liver cirrhosis. BTR was significantly decreased in patients with cirrhosis and hepatitis compared with healthy subjects. BTR was significantly correlated with the Child-Pugh score and with other liver function tests. BCAA increased significantly 2 hr after BCAA administration and decreased gradually thereafter. Tyr significantly decreased 4 hr after BCAA administration. BTR significantly increased 2 and 4 hr after BCAA therapy. The increase in BTR 3 hr after BCAA administration was low in patients with decreased basal BTR. The results of this study showed that BTR is a good index of the hepatic parenchymal damage and that it may be a useful marker for monitoring response to nutritional therapy in patients with chronic liver disease.

Prognostic Impact of Preoperative the Branched-Chain Amino Acid to the Tyrosine Ratio in Hepatocellular Carcinoma Patients after Initial Hepatectomy

“…However, the correlation with ALB was reported to vary widely from R=0.447 15 to R=0.538, 14 and the present results were within this range. BTR was correlated with serum protein levels rather than bilirubin levels, 14,17,19 which reflects the correlation between BTR and maintenance of serum protein levels. The reason why the correlation varied among the evaluated proteins could be that BTR only reflected a part of the activities of protein synthesis at the time of stable rest, and the serum protein level does not always determine the rate of synthesis.…”

Branched-chain amino acids as pharmacological nutrients in chronic liver disease

“…Approximately 45% of enrolled patients were Child‐Pugh class A in the former study,16 whereas all the patients were Child‐Pugh class B or C in the latter study 15. The BCAA/AAA ratio decreases along with progression of liver cirrhosis 27. Because the BCAA/AAA ratio is positively correlated with the synthesis and secretion of albumin,4 and the response to BCAA treatment,27 a low BCAA/AAA ratio may be a reason for the discrepancy in results between the studies.…”

“…The BCAA/AAA ratio decreases along with progression of liver cirrhosis 27. Because the BCAA/AAA ratio is positively correlated with the synthesis and secretion of albumin,4 and the response to BCAA treatment,27 a low BCAA/AAA ratio may be a reason for the discrepancy in results between the studies. In addition, the majority of other randomized, controlled trials have demonstrated that BCAA supplementation results in a significant increase in serum albumin levels in patients with cirrhosis (Supporting Table 1).…”

Effect of oral supplementation with branched-chain amino acid granules in the early stage of cirrhosis

“…During this treatment, as an indicator of disorders of amino acid metabolism, we used the BCAA/tyrosine ratio (BTR, Ono Pharmaceutical Co., Ltd., Osaka, Japan) instead of the Fischer's ratio. The measurement method of BTR is simple and inexpensive, and BTR can generally be a substitute for the Fischer's ratio and is being commonly used in Japan [20][21][22]. Prior to this study, we divided the patients with Child A liver cirrhosis in the compensatory stage, who were enrolled from March 1996 to July 1997, into two groups: the BTR ≥ 4 group (57 patients) and the BTR < 4 group (27 patients), and followed them up for 4 years.…”