title: The effect of L-ornithine L-aspartate and branch chain amino acids on encephalopathy and nutritional status in liver cirrhosis with malnutrition.
abstract: OBJECTIVE
  to determine the effect of L-ornithine-L-aspartate (LOLA) together with the nutritional improvement and branched chain amino acids (BCAAs) substitution, on encephalopathy in liver cirrhosis with malnutrition.
  
  
  METHODS
  liver cirrhosis patients visited Cipto mangunkusumo Hospital in June-October 2009 were evaluated by critical flicker frequency (CFF) test. Encephalopathy is defined when CFF <39 Hz. Nutritional status is measured by the mid-arm muscle circumference (MAMC) and is stated as malnutrition when MAMC <15%. All subjects who fulfilled the inclusion criteria received education for adequate calories and protein intake, and then they were be divided into 2 groups by randomization. One group was given LOLA granules 3 x 6 g/d for 2 weeks, while another group was not. Then their prealbumin and CFF test were measured again. Statistical analysis conducted for this double blind randomized clinical trial was independent student t test.
  
  
  RESULTS
  there were 34 liver cirrhosis patients fit the inclusion criteria, and by randomization 17 subjects were put into group A (received LOLA) and 17 subjects into group B (without LOLA). Statistical analysis obtained the statistically significant (p=0,016) of increasing of the mean CFF value in group A (2.41 ± 1.6 Hz) compared to group B (0.67 ± 2.3 Hz). However, there was not significant increasing of prealbumin level in group A compared to group B (1 ± 1.3 mg/dL vs 1.2 ± 1.4 mg/dL, respectively (p=0,59). Furthermore, after 2 weeks of treatment there was no significant increase of ureum and creatinine level in both groups (4 ± 0.5 mg/dL vs 9.3 ± 1.3 mg/dL, (p=0.4) for ureum, -0.1 (0.1) mg/dL vs 0.1 ± 0.1 mg/dL, (p=0.3) for creatinine.
  
  
  CONCLUSIONS
  minimal hepatic encephalopathy with malnutrition can be given a diet of 35-40 cal/kgBW and 1.5 g protein/kgBW including BCAA substitution to improve nutritional status, and LOLA granules can be given to improve encephalopathy.
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, University of Indonesia - Dr. Cipto Mangunkusumo Hospital, Jl. Diponegoro no. 71, Jakarta Pusat 10430, Indonesia. susan_ndraha@yahoo.co.id
authors.forename: Suzanna
authors.initials: S
authors.lastname: Ndraha
authors.forename: Irsan
authors.initials: I
authors.lastname: Hasan
authors.forename: Marcellus
authors.initials: M
authors.lastname: Simadibrata
mesh_terms: D000328:Adult; D000368:Aged; D000418:Albumins / Q000378:metabolism; D000597:Amino Acids, Branched-Chain / Q000627:therapeutic use*; D000641:Ammonia / Q000097:blood; D004044:Dietary Proteins / Q000008:administration & dosage / Q000378:metabolism; D004151:Dipeptides / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006501:Hepatic Encephalopathy / Q000188:drug therapy* / Q000209:etiology / Q000235:genetics; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D008297:Male; D044342:Malnutrition / Q000188:drug therapy* / Q000209:etiology; D008875:Middle Aged; D009752:Nutritional Status; D055815:Young Adult
chemical_list: D000418:Albumins; D000597:Amino Acids, Branched-Chain; D004044:Dietary Proteins; D004151:Dipeptides; D000641:Ammonia; C002939:ornithylaspartate