title: Update on nutritional supplementation with branched-chain amino acids.
abstract: OBJECTIVE
  Branched-chain amino acids (BCAAs) have a peculiar role in whole-body nitrogen metabolism. BCAAs are not only a substrate for protein synthesis, but also modulate several components of the synthetic machinery and help to conserve muscle mass; accordingly, several conditions, characterized by protein loss and catabolic status, are likely to benefit from amino acid administration. In addition, the competitive action of BCAAs on amino acid transport across the blood-brain barrier may ultimately alter the synthesis of brain neurotransmitters, involved in neurological diseases.
  
  
  RESULTS
  Both putative actions of BCAAs have been tested in controlled clinical studies in the last few years. The beneficial effects on nutrition were reported to improve muscle performance, reduce protein loss during bed-rest, favor weight loss in obesity, reduce catabolism in trauma patients and improve clinical outcomes in patients with advanced cirrhosis. In this last area, the effects on nutrition might be coupled with the effects on hepatic encephalopathy mediated by improved neurotransmission, successfully tested in mania, tardive dyskinesia and spinocerebellar degeneration.
  
  
  CONCLUSIONS
  After 30 years of investigation with BCAAs, new studies each year provide further evidence supporting their beneficial effect in a variety of diseases. There is a need for long-term, randomized clinical studies, both in the prevention and in the treatment of various pathological conditions.
authors.affiliation: Department of Internal Medicine, Alma Mater Studiorum University of Bologna, Bologna, Italy.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Bianchi
authors.forename: Rebecca
authors.initials: R
authors.lastname: Marzocchi
authors.forename: Federica
authors.initials: F
authors.lastname: Agostini
authors.forename: Giulio
authors.initials: G
authors.lastname: Marchesini
mesh_terms: D000597:Amino Acids, Branched-Chain / Q000008:administration & dosage* / Q000627:therapeutic use; D001921:Brain / Q000378:metabolism*; D019587:Dietary Supplements; D005943:Gluconeogenesis; D006801:Humans; D008107:Liver Diseases / Q000628:therapy; D018482:Muscle, Skeletal / Q000378:metabolism*; D018377:Neurotransmitter Agents / Q000378:metabolism; D009765:Obesity / Q000628:therapy
chemical_list: D000597:Amino Acids, Branched-Chain; D018377:Neurotransmitter Agents