Role of meal carbohydrate content for the imbalance of plasma amino acids in patients with liver cirrhosis.
OBJECTIVE
Imbalance of circulating branched chain amino acids (BCAA) versus aromatic amino acids (AAA) and hyperinsulinemia are common metabolic alterations in patients with liver cirrhosis. The aim of this study was to characterize the effect of the carbohydrate component of a protein-rich mixed meal on postprandial plasma concentrations of 21 amino acids, insulin and C-peptide in patients with compensated liver cirrhosis. Furthermore, the effect of a dietary intervention on the metabolic alterations in cirrhotic patients was examined.


METHODS
Eighteen patients with cirrhosis and 12 healthy volunteers received a protein-rich meal (pork filet 200 g) with or without carbohydrates (bread 50 g, glucose 20 g). A subgroup of four cirrhotic patients received an isoenergetic (117 kJ/kg bw) carbohydrate-enriched (60%) and -restricted (20%) diet for 7 days each.


RESULTS
In the cirrhotic patients, basal plasma insulin and C-peptide concentrations were significantly elevated. The ingestion of a protein-rich meal without additional carbohydrates led to a significantly greater increase of insulin and C-peptide in the cirrhotic patients compared to controls. Postprandial increases of leucine and isoleucine were reduced, whereas those of phenylalanine were higher in cirrhotic patients. The addition of carbohydrates led to higher insulin and C-peptide plasma concentrations in cirrhotic patients. Postprandial BCAA increases were more impaired in the cirrhotic group after additional carbohydrate ingestion (46%vs 82%). After the carbohydrate-restricted diet for 7 days BCAA plasma levels increased but the BCAA/AAA ratio remained unaltered.


CONCLUSIONS
The carbohydrate content of a meal enhances reduction of BCAA plasma concentrations in clinically stable cirrhotic patients. An imbalanced BCAA/AAA ratio cannot be avoided by a carbohydrate-reduced diet alone, supporting mandatory BCAA supplementation.
Schulte-Frohlinde
Ewert
E
Department of Medicine II, Technical University of Munich, Munich, Germany. ewert-schulte-frohlinde@lrz.tum.de
Wagenpfeil
Stefan
S
Willis
Johanna
J
Lersch
Christian
C
Eckel
Florian
F
Schmid
Roland
R
Schusdziarra
Volker
V
D000328:Adult; D000596:Amino Acids / Q000097:blood*; D024322:Amino Acids, Aromatic / Q000097:blood; D000597:Amino Acids, Branched-Chain / Q000097:blood; D002096:C-Peptide / Q000097:blood; D002940:Circadian Rhythm; D004040:Dietary Carbohydrates / Q000008:administration & dosage*; D004044:Dietary Proteins / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007328:Insulin / Q000031:analogs & derivatives / Q000097:blood; D049528:Insulin, Long-Acting; D008103:Liver Cirrhosis / Q000097:blood / Q000178:diet therapy*; D008297:Male; D008875:Middle Aged
D000596:Amino Acids; D024322:Amino Acids, Aromatic; D000597:Amino Acids, Branched-Chain; D002096:C-Peptide; D004040:Dietary Carbohydrates; D004044:Dietary Proteins; D007328:Insulin; D049528:Insulin, Long-Acting