title: Effects of oral branched-chain amino acid granules on event-free survival in patients with liver cirrhosis.
abstract: OBJECTIVE
  Nutritional intervention with branched-chain amino acid (BCAA) is reported to increase serum albumin concentration in patients with decompensated cirrhosis. However, a definite conclusion on whether it can improve patients' survival has not yet been reached. The present study aimed to test possibilities of improving survival of patients with decompensated cirrhosis by using a BCAA preparation that is suitable for long-term oral administration.
  
  
  METHODS
  A multicenter, randomized, and nutrient intake-controlled trial on the comparative effects of BCAA orally administered at 12 g/day for 2 years versus diet therapy with defined daily food intake (1.0-1.4 g protein kg(-1) day(-1) including BCAA preparation and 25-35 kcal kg(-1) day(-1)) was conducted in 646 patients with decompensated cirrhosis. The primary end point was a composite of death by any cause, development of liver cancer, rupture of esophageal varices, or progress of hepatic failure (event-free survival). The secondary end points were serum albumin concentration and health-related quality of life (QOL) measured by Short Form-36 questionnaire.
  
  
  RESULTS
  The incidence of events comprising the primary end point significantly decreased in the BCAA group as compared with the diet group (hazard ratio, 0.67; 95% confidence interval, 0.49-0.93; P = .015; median observation period, 445 days). Serum albumin concentration increased significantly in the BCAA group as compared with the diet group (P = .018). The "general health perception" domain in Short Form-36 measures was also improved (P = .003). Patients' adherence to the prescription was favorable.
  
  
  CONCLUSIONS
  Oral supplementation with a BCAA preparation that can be administered for a long period improves event-free survival, serum albumin concentration, and QOL in patients with decompensated cirrhosis with an adequate daily food intake.
authors.affiliation: Gifu University, Gifu, Japan. ichi-nai@cc.gifu-u.ac.jp
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Muto
authors.forename: Shunichi
authors.initials: S
authors.lastname: Sato
authors.forename: Akiharu
authors.initials: A
authors.lastname: Watanabe
authors.forename: Hisataka
authors.initials: H
authors.lastname: Moriwaki
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Suzuki
authors.forename: Akinobu
authors.initials: A
authors.lastname: Kato
authors.forename: Masahiko
authors.initials: M
authors.lastname: Kato
authors.forename: Teiji
authors.initials: T
authors.lastname: Nakamura
authors.forename: Kiyohiro
authors.initials: K
authors.lastname: Higuchi
authors.forename: Shuhei
authors.initials: S
authors.lastname: Nishiguchi
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Kumada
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000597:Amino Acids, Branched-Chain / Q000008:administration & dosage*; D019587:Dietary Supplements; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D007564:Japan; D008103:Liver Cirrhosis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality*; D017093:Liver Failure / Q000209:etiology / Q000517:prevention & control; D008113:Liver Neoplasms / Q000209:etiology / Q000517:prevention & control; D008297:Male; D008875:Middle Aged
chemical_list: D000597:Amino Acids, Branched-Chain