title: Nocturnal branched-chain amino acid administration improves protein metabolism in patients with liver cirrhosis: comparison with daytime administration.
abstract: BACKGROUND
  In an attempt to optimize oral branched-chain amino acid (BCAA) administration to improve serum albumin in cirrhotic patients, we compared the effects of nocturnal and daytime BCAA administration on protein metabolism in cirrhotic patients.
  
  
  METHODS
  Twelve cirrhotic patients were enrolled in a short-term study. Patients were administered either conventional daytime BCAA granule or nocturnal BCAA for a week, and metabolic analyses were performed, followed by a crossover study in the next week. Another 12 patients, who showed no improvement of serum albumin level with previous daytime BCAA administration, were randomly assigned to either a nocturnal or a daytime BCAA administration group in a long-term study.
  
  
  RESULTS
  Low Fischer's ratio, reduced respiratory quotient, and low serum albumin were observed at entry in cirrhotic patients. Whereas daytime BCAA administration improved nitrogen balance and Fischer's ratio, these 2 were further significantly improved after nocturnal BCAA administration. There were no changes in parameters of energy metabolism throughout the study. In the 3-month follow-up, a significant increase in serum albumin was observed in patients administered nocturnal BCAA but not in those administered daytime BCAA.
  
  
  CONCLUSIONS
  Nocturnal BCAA administration improved serum albumin in cirrhotic patients who showed no improvement in serum albumin level with daytime BCAA administration. This effect could be partly caused by the improved protein sparing with this administration method.
authors.affiliation: First Department of Internal Medicine, Gifu University School of Medicine, Gifu, Japan.
authors.forename: Hideki
authors.initials: H
authors.lastname: Fukushima
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Miwa
authors.forename: Erika
authors.initials: E
authors.lastname: Ida
authors.forename: Shoko
authors.initials: S
authors.lastname: Kuriyama
authors.forename: Katsuhisa
authors.initials: K
authors.lastname: Toda
authors.forename: Yoriko
authors.initials: Y
authors.lastname: Shimomura
authors.forename: Akihiko
authors.initials: A
authors.lastname: Sugiyama
authors.forename: Jun'ichi
authors.initials: J
authors.lastname: Sugihara
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tomita
authors.forename: Hisataka
authors.initials: H
authors.lastname: Moriwaki
mesh_terms: D000284:Administration, Oral; D000368:Aged; D000597:Amino Acids, Branched-Chain / Q000008:administration & dosage* / Q000378:metabolism; D002940:Circadian Rhythm / Q000502:physiology*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000378:metabolism* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011502:Protein-Energy Malnutrition / Q000150:complications / Q000628:therapy*; D011506:Proteins / Q000378:metabolism*; D012709:Serum Albumin / Q000032:analysis / Q000187:drug effects
chemical_list: D000597:Amino Acids, Branched-Chain; D011506:Proteins; D012709:Serum Albumin