title: Update on branched-chain amino acid supplementation in liver diseases.
abstract: OBJECTIVE
  Branched-chain amino acids (BCAAs) have a peculiar role in whole-body nitrogen metabolism. BCAAs are a substrate for protein synthesis, and have been used to conserve or restore muscle mass in advanced liver disease. In addition, the competitive action of BCAAs on amino acid transport across the blood-brain barrier may improve hepatic encephalopathy.
  
  
  RESULTS
  The effects of branched-chain amino acids on nutrition and ultimately on prognosis of patients with advanced cirrhosis have been confirmed in a large multicenter, long-term trial. Similarly, BCAA treatment improved the prognosis of patients with hepatocellular carcinoma, treated by chemoembolization. The mechanism for the beneficial effects of BCAA is likely to depend on the stimulating activity of BCAA on hepatocyte growth factor, favoring liver regeneration.
  
  
  CONCLUSIONS
  After an experience of 25 years with branched-chain amino acids, new data supports their beneficial effect in liver diseases. Although the number of patients who cannot tolerate dietary proteins in amounts sufficient to meet their increased catabolism is probably low, in this specific setting BCAAs remain the sole treatment of proved efficacy.
authors.affiliation: Department of Internal Medicine, 'Alma Mater Studiorum' University of 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 / Q000627:therapeutic use*; D019454:Chronotherapy; D006801:Humans; D008107:Liver Diseases / Q000188:drug therapy*
chemical_list: D000597:Amino Acids, Branched-Chain