title: Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy. marchreg@med.unibo.it
authors.forename: Giulio
authors.initials: G
authors.lastname: Marchesini
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bianchi
authors.forename: Manuela
authors.initials: M
authors.lastname: Merli
authors.forename: Piero
authors.initials: P
authors.lastname: Amodio
authors.forename: Carmine
authors.initials: C
authors.lastname: Panella
authors.forename: Carmela
authors.initials: C
authors.lastname: Loguercio
authors.forename: Fillipo
authors.initials: F
authors.lastname: Rossi Fanelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Abbiati
mesh_terms: 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
chemical_list: D000597:Amino Acids, Branched-Chain