title: Nutritional support in children with end-stage liver disease: a randomized crossover trial of a branched-chain amino acid supplement.
abstract: Malnutrition is common in children with end-stage liver disease (ESLD) awaiting orthotopic liver transplantation (OLT), and nutritional support is assuming an important role in preoperative management. To evaluate preoperative nutritional therapy, 19 children (median age 1.25 y) with ESLD awaiting OLT were prospectively studied. Two high-energy, isoenergetic and isonitrogenous nutritional formulations delivered nasogastrically were compared: a branched-chain amino acid (BCAA)-enriched semielemental formulation and a matched standard semielemental formation. Twelve of 19 patients completed a randomized controlled study before OLT and 10 of 19 completed a full crossover study. Improvements in weight and height occurred during the BCAA supplements, with no statistical change on the standard formulation. Significant increases in total body potassium, midupper arm circumference, and subscapular skinfold thickness occurred during the BCAA supplements, whereas no significant changes occurred during the standard formulation period. Significantly fewer albumin infusions were required during the BCAA supplement. These findings suggest that BCAA-enriched formulas have advantages over standard semielemental formulas in improving nutritional status in children with ESLD, and are deserving of wider application and study.
authors.affiliation: Queensland Liver Transplant Service, Royal Children's Hospital, Brisbane, Australia.
authors.forename: S E
authors.initials: SE
authors.lastname: Chin
authors.forename: R W
authors.initials: RW
authors.lastname: Shepherd
authors.forename: B J
authors.initials: BJ
authors.lastname: Thomas
authors.forename: G J
authors.initials: GJ
authors.lastname: Cleghorn
authors.forename: M K
authors.initials: MK
authors.lastname: Patrick
authors.forename: J A
authors.initials: JA
authors.lastname: Wilcox
authors.forename: T H
authors.initials: TH
authors.lastname: Ong
authors.forename: S V
authors.initials: SV
authors.lastname: Lynch
authors.forename: R
authors.initials: R
authors.lastname: Strong
mesh_terms: D000418:Albumins / Q000008:administration & dosage; D000596:Amino Acids / Q000097:blood; D000597:Amino Acids, Branched-Chain / Q000627:therapeutic use*; D000886:Anthropometry; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008107:Liver Diseases / Q000150:complications / Q000178:diet therapy* / Q000601:surgery; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D011188:Potassium / Q000032:analysis; D011300:Preoperative Care; D011446:Prospective Studies; D011502:Protein-Energy Malnutrition / Q000517:prevention & control*
chemical_list: D000418:Albumins; D000596:Amino Acids; D000597:Amino Acids, Branched-Chain; D011188:Potassium