title: Effects of branched-chain amino acids supplementation in patients with cirrhosis and a previous episode of hepatic encephalopathy: a randomized study.
abstract: OBJECTIVE
  Protein intake impacts on nutritional status and may determine the recurrence of hepatic encephalopathy (HE). A low-protein diet has been considered the standard treatment after an episode of HE, while branched-chain amino acids (BCAA) have been shown to improve minimal HE. We performed a study to investigate the long-term effects of supplementing a protein-controlled diet with BCAA.
  
  
  METHODS
  A randomized, double-blind, multicenter study that included 116 patients with cirrhosis and a previous episode of HE was conducted in four tertiary care hospitals. All patients received a standard diet of 35 kcal/kg per day and 0.7 g of proteins/kg per day and a supplement of 30 g of BCAA (BCAA group) or maltodextrin (MDX group) during 56 weeks.
  
  
  RESULTS
  The actuarial risk of remaining free of HE did not differ between groups (BCAA=47%, MDX=34%, P=0.274), but patients in the BCAA group exhibited a better outcome on two neuropsychological tests and an increase in the mid-arm muscle circumference. Recurrence was associated with low plasma albumin at baseline and a decrease in sodium and an increase in creatinine during follow-up. Patients with recurrence of HE exhibited a lack of improvement in global cognitive function.
  
  
  CONCLUSIONS
  Diet supplementation with BCAA after an episode of HE does not decrease recurrence of HE. However, supplementation with BCAA improves minimal HE and muscle mass. Identification of risk factors for recurrence of HE may allow the development of new preventive therapies that could decrease the neuropsychological sequelae of repeated episodes of HE.
authors.affiliation: Servei de Medicina Interna-Hepatologia, Hospital Vall d'Hebron, Barcelona, Spain.
authors.forename: Iñigo
authors.initials: I
authors.lastname: Les
authors.forename: Eduardo
authors.initials: E
authors.lastname: Doval
authors.forename: Rita
authors.initials: R
authors.lastname: García-Martínez
authors.forename: Mercè
authors.initials: M
authors.lastname: Planas
authors.forename: Guillermo
authors.initials: G
authors.lastname: Cárdenas
authors.forename: Pilar
authors.initials: P
authors.lastname: Gómez
authors.forename: Montse
authors.initials: M
authors.lastname: Flavià
authors.forename: Carlos
authors.initials: C
authors.lastname: Jacas
authors.forename: Beatriz
authors.initials: B
authors.lastname: Mínguez
authors.forename: Mercedes
authors.initials: M
authors.lastname: Vergara
authors.forename: Germán
authors.initials: G
authors.lastname: Soriano
authors.forename: Carmen
authors.initials: C
authors.lastname: Vila
authors.forename: Rafael
authors.initials: R
authors.lastname: Esteban
authors.forename: Juan
authors.initials: J
authors.lastname: Córdoba
mesh_terms: D000368:Aged; D000597:Amino Acids, Branched-Chain / Q000627:therapeutic use*; D000704:Analysis of Variance; D001707:Biopsy, Needle; D018753:Diet, Protein-Restricted; D019587:Dietary Supplements; D018572:Disease-Free Survival; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006501:Hepatic Encephalopathy / Q000517:prevention & control*; D006801:Humans; D007150:Immunohistochemistry; D008103:Liver Cirrhosis / Q000178:diet therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011134:Polysaccharides / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D000597:Amino Acids, Branched-Chain; D011134:Polysaccharides; C008315:maltodextrin