Plasma amino acid response to protein ingestion in patients with liver cirrhosis

Marchesini, Giulio; Bianchi, Giampaolo; Zoli, Marco; Dondi, Cristina; Forlani, Gabriele; Melli, A; Bua, Vincenzo; Vannini, P; Pisi, E

doi:10.1016/0016-5085(83)90312-8

Cited by 30 publications

(14 citation statements)

References 27 publications

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“…In advanced liver disease there is usually an increased concentration of the AAA tyrosine, phenylalanine and tryptophan, and decreased concentration of the BCAA leucine, isoleucine and valine[3,4,6,9,14]. We have previously reported differences between different stages of liver disease and small or no significant differences between patients with stable liver disease and normal subjects[26].…”

Section: Discussionmentioning

confidence: 99%

“…In most previous studies the methods for patient selection ( i.e ., disease severity) and nutritional intervention (type and dose of protein or amino acid formula) have varied widely, with very few controlled studies involving a “natural” meal[14,31,35,37]. This precludes the opportunity to make firm interpretations of the metabolic alterations in cirrhotic patients.…”

Section: Discussionmentioning

confidence: 99%

“…The higher BCAA and AAA increases observed in cirrhotics may be explained by their peripheral insulin resistance[14] which results in reduced muscle uptake of BCAA and a decreased inhibition of muscle catabolism after food intake. In previous studies, patients at different stages of liver disease were given either a protein load (ranging from 27 to 48 g)[3,14-16,31] or BCAA-enriched formulae[3,9] and showed amino acid “intolerance” to that load of protein or amino acids. The term “intolerance” here being based on a persistent increase of amino acids in plasma[40,41].…”

Section: Discussionmentioning

confidence: 99%

“…However, both the type and dosage of protein feed or formula and/or the routes of administration have been varied[3,14-17]. Nevertheless, even though most nutritional guidelines recommend high protein diets for liver cirrhosis protein restriction is still considered appropriate in some clinics[18,19].…”

Section: Introductionmentioning

confidence: 99%

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Protein tolerance to standard and high protein meals in patients with liver cirrhosis

Campollo

Sprengers

Dam

et al. 2017

WJH

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AIMTo investigate the plasma amino acid response and tolerance to normal or high protein meals in patients with cirrhosis.METHODSThe plasma amino acid response to a 20 g mixed protein meal was compared in 8 biopsy-proven compensated cirrhotic patients and 6 healthy subjects. In addition the response to a high protein meal (1 g/kg body weight) was studied in 6 decompensated biopsy-proven cirrhotics in order to evaluate their protein tolerance and the likelihood of developing hepatic encephalopathy (HE) following a porto-caval shunt procedure. To test for covert HE, the “number connection test” (NCT) was done on all patients, and an electroencephalogram was recorded in patients considered to be at Child-Pugh C stage.RESULTSThe changes in plasma amino acids after a 20 g protein meal were similar in healthy subjects and in cirrhotics except for a significantly greater increase (P < 0.05) in isoleucine, leucine and tyrosine concentrations in the cirrhotics. The baseline branched chain amino acids/aromatic amino acids (BCAA/AAA) ratio was higher in the healthy persons and remained stable-but it decreased significantly after the meal in the cirrhotic group. After the high protein meal there was a marked increase in the levels of most amino acids, but only small changes occurred in the levels of taurine, citrulline, cysteine and histidine.The BCAA/AAA ratio was significantly higher 180 and 240 min after the meal. Slightly elevated basal plasma ammonia levels showed no particular pattern. Overt HE was not observed in any patients.CONCLUSIONPatients with stable liver disease tolerate natural mixed meals with a standard protein content. The response to a high protein meal in decompensated cirrhotics suggests accumulation of some amino acids but it did not precipitate HE. These results support current nutritional guidelines that recommend a protein intake of 1.2-1.5 g/kg body weight/day for patients with cirrhosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Protein tolerance to standard and high protein meals in patients with liver cirrhosis

Campollo

Sprengers

Dam

et al. 2017

WJH

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“…Metabolic states in which insulin is deficient or its action is impaired have been associated with both raised fasting levels of plasma BCAA and reduced postprandial clearance of BCAA (45).…”

Section: Discussionmentioning

confidence: 99%

Metabolic Effects of Reducing Rate of Glucose Ingestion by Single Bolus Versus Continuous Sipping

et al. 1990

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Modifying the rate of absorption has been proposed as a therapeutic principle of specific relevance to diabetes. To demonstrate clearly the metabolic benefits that might result from reducing the rate of nutrient delivery, nine healthy volunteers took 50 g glucose in 700 ml water on two occasions: over 5-10 min (bolus) and at a constant rate over 3.5 h (sipping). Despite similar 4-h blood glucose areas, large reductions were seen in serum insulin (54 +/- 10%, P less than 0.001) and C-peptide (47 +/- 12%, P less than 0.01) areas after sipping, together with lower gastric inhibitory polypeptide and enteroglucagon levels and urinary catecholamine output. There was also prolonged suppression of plasma glucagon, growth hormone, and free-fatty acid (FFA) levels after sipping, whereas these levels rose 3-4 h after the glucose bolus. An intravenous glucose tolerance test at 4 h demonstrated a 48 +/- 10% (P less than 0.01) more rapid decline in blood glucose (Kg) after sipping than after the bolus. Furthermore, FFA and total branched-chain amino acid levels as additional markers of insulin action were lower over this period despite similar absolute levels of insulin and C-peptide. These findings indicate that prolonging the rate of glucose absorption enhances insulin economy and glucose disposal.

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Pathophysiology of gastrointestinal circulation

Gallavan

Parks

Jacobson

1989

Comprehensive Physiology

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Plasma amino acid response to protein ingestion in patients with liver cirrhosis

Cited by 30 publications

References 27 publications

Protein tolerance to standard and high protein meals in patients with liver cirrhosis

Protein tolerance to standard and high protein meals in patients with liver cirrhosis

Metabolic Effects of Reducing Rate of Glucose Ingestion by Single Bolus Versus Continuous Sipping

Pathophysiology of gastrointestinal circulation

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