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

Abstract

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.

Muscle wasting and branched‐chain amino acid, alpha‐ketoglutarate, and ATP depletion in a rat model of liver cirrhosis

“…Of special importance are hyperammonaemia, hypoalbuminaemia, low BCAA and high aromatic amino acids, as well as decreased urea and glucose levels. Decreased blood plasma concentrations of BCAA and increased concentrations of aromatic amino acids in blood plasma found in cirrhotic rats are characteristic for subjects with liver cirrhosis, but not for acute liver injury . The BCAA deficiency and their positive effects on protein metabolism in muscles provide a clear rationale to recommend their supplementation in patients with cirrhosis.…”

“…HOLEČEK and VOdEnIČaROVOVÁ characteristic for subjects with liver cirrhosis, 25,26 but not for acute liver injury. 27 The BCAA deficiency and their positive effects on protein metabolism in muscles provide a clear rationale to recommend their supplementation in patients with cirrhosis.…”

Plasma Amino Acid Concentration in the Hepatic Vein Compared to Peripheral Blood

“…skeletal muscle. 18 A characteristic pattern of plasma amino acids has been described in cirrhotic subjects [4][5][6][7][8][9]19,20 and metabolic and biochemical differences have been shown between stable and unstable cirrhotics. 4 In this study we observed the characteristic pattern of increased concentration of the aromatic amino-acids (AAA) tyrosine, phenylalanine and tryptophan, and decreased concentration of branched-chain amino acids (BCAA) leucine, isoleucine and valine.…”

Aktualisierte S2k-Leitlinie der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) „Komplikationen der Leberzirrhose“

“…Allenfalls bei Patienten mit HE und oberer gastrointestinaler Blutung kann für drei bis fünf Tage auf eine Proteinzufuhr verzich-tet werden [584]. Das Auftreten weiterer HE-Episoden wird durch eine normale Proteinkost unter Fortführung einer HE-Standardtherapie in der Regel nicht begünstigt [117,570].…”