Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial.
OBJECTIVE
The role of oral supplementation with branched-chain amino acids (BCAA) in advanced cirrhosis is far from settled. A nutritional approach might prevent progressive liver failure and improve nutritional parameters and quality of life.


METHODS
A multicenter, randomized study comparing 1-year nutritional supplementation with BCAA against lactoalbumin or maltodextrins was performed in 174 patients with advanced cirrhosis. Primary outcomes were the prevention of a combined end point (death and deterioration to exclusion criteria), the need for hospital admission, and the duration of hospital stay. Secondary outcomes were nutritional parameters, laboratory data and Child-Pugh score, anorexia, health-related quality of life, and need for therapy.


RESULTS
Treatment with BCAA significantly reduced the combined event rates compared with lactoalbumin (odds ratio, 0.43; 95% confidence interval, 0.19-0.96; P = 0.039) and nonsignificantly compared with maltodextrins (odds ratio, 0.51; 95% confidence interval, 0.23-1.17; P = 0.108). The average hospital admission rate was lower in the BCAA arm compared with control treatments (P = 0.006 and P = 0.003, respectively). In patients who remained in the study, nutritional parameters and liver function tests were, on average, stable or improved during treatment with BCAA and the Child-Pugh score decreased (P = 0.013). Also, anorexia and health-related quality of life (SF-36 questionnaire) improved. Long-term compliance with BCAA was poor.


CONCLUSIONS
In advanced cirrhosis, long-term nutritional supplementation with oral BCAA is useful to prevent progressive hepatic failure and to improve surrogate markers and perceived health status. New formulas are needed to increase compliance.
Marchesini
Giulio
G
Department of Internal Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy. marchreg@med.unibo.it
Bianchi
Giampaolo
G
Merli
Manuela
M
Amodio
Piero
P
Panella
Carmine
C
Loguercio
Carmela
C
Rossi Fanelli
Fillipo
F
Abbiati
Roberto
R
D000597:Amino Acids, Branched-Chain / Q000008:administration & dosage*; D000855:Anorexia / Q000453:epidemiology; D019587:Dietary Supplements; D004311:Double-Blind Method; D005260:Female; D006304:Health Status; D006801:Humans; D008099:Liver / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support; D011788:Quality of Life
D000597:Amino Acids, Branched-Chain