Branched Chain Amino Acid Supplementation for Patients with Cirrhosis | Clinical Correl... - 0 views
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BCCA branched chain amino acids liver cirrhosis hepatitis amino acids
shared by Nathan Goodyear on 05 Oct 15
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low level of BCAAs in patients with cirrhosis is hypothesized to be one of multiple factors responsible for development of hepatic encephalopathy
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supplementation of BCAAs is thought to facilitate ammonia detoxification by supporting synthesis of glutamine, one of the non-branched chain amino acids, in skeletal muscle and in the brain as well as diminishing the influx of AAAs across the blood-brain barrier
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oral BCAA supplementation is more useful in chronic encephalopathic patients than is parenteral BCAA supplementation in patients with acute encephalopathy
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malnutrition progressing to cachexia is another common manifestation of cirrhosis
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Malnutrition can be mitigated with BCAA supplementation
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Studies show that administration of amino acid formulas enriched with BCAAs can reduce protein loss, support protein synthesis, and improve nutritional status of patients with chronic liver disease
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Leucine has been shown to be the most effective of the BCAAs because it acts via multiple pathways to stimulate protein synthesis
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BCAAs metabolites inhibit proteolysis
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Patients with cirrhosis have both insulin deficiency and insulin resistance
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BCAAs (particularly leucine) help to reverse the catabolic, hyperglucagonemic state of cirrhosis both by stimulating insulin release from the pancreatic β cells and by decreasing insulin resistance allowing for better glucose utilization
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Coadministration of BCAAs and glucose has been found to be particularly useful
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BCAA supplementation improves protein-energy malnutrition by improving utilization of glucose, thereby diminishing the drive for proteolysis, inhibiting protein breakdown, and stimulating protein synthesis
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Cirrhotic patients have impaired immune defense, characterized by defective phagocytic activity and impaired intracellular killing activity
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another effect of BCAA supplementation is improvement of phagocytic function of neutrophils and possibly improvement in natural killer T (NKT) cell lymphocyte activity
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BCAA supplementation may reduce the risk of infection in patients with advanced cirrhosis not only through improvement in protein-energy malnutrition but also by directly improving the function of the immune cells themselves
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BCAA administration has also been shown to have a positive effect on liver regeneration
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A proposed mechanism for improved liver regeneration is the stimulatory effect of BCAAs (particularly leucine) on the secretion of hepatocyte growth factor by hepatic stellate cells
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BCAAs activate rapamycin signaling pathways which promotes albumin synthesis in the liver as well as protein and glycogen synthesis in muscle tissue
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Chemical improvement with BCAA treatment is demonstrated by recovery of serum albumin and lowering of serum bilirubin levels
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long-term oral BCAA supplementation was useful in staving off malnutrition and improving survival by preventing end-stage fatal complications of cirrhosis such as hepatic failure and gastrointestinal bleeding
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The incidence of death by any cause, development of liver cancer, rupture of esophageal varices, or progression to hepatic failure was decreased in the group that received BCAA supplementation
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Patients receiving BCAA supplementation also have a lower average hospital admission rate, better nutritional status, and better liver function tests
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patients taking BCAA supplementation report improved quality of life
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BCAAs have been shown to mitigate hepatic encephalopathy, cachexia, and infection rates, complications associated with the progression of hepatic cirrhosis
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BCAAs make up 20-25% of the protein content of most foods
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Highest levels are found in casein whey protein of dairy products and vegetables, such as corn and mushrooms. Other sources include egg albumin, beans, peanuts and brown rice bran
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In addition to BCAAs from diet, oral supplements of BCAAs can be used
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Oral supplementation tends to provide a better hepatic supply of BCAAs for patients able to tolerate PO nutrition as compared with IV supplementation, especially when treating symptoms of hepatic encephalopathy
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Coadministration of BCAAs with carnitine and zinc has also been shown to increase ammonia metabolism further reducing the encephalopathic symptoms
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Cirrhotic patients benefit from eating frequent, small meals that prevent long fasts which place the patient in a catabolic state
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the best time for BCAA supplementation is at bedtime to improve the catabolic state during starvation in early morning fasting
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A late night nutritional snack reduces symptoms of weakness and fatigability, lowers postprandial hyperglycemia, increases skeletal muscle mass,[25] improves nitrogen balance, and increases serum albumin levels.[26] Nocturnal BCAAs even improve serum albumin in cirrhotic patients who show no improvement with daytime BCAAs
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Protein-energy malnutrition (PEM), with low serum albumin and low muscle mass, occurs in 65-90% of cases of advanced cirrhosis
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hyperglucagonemia results in a catabolic state eventually producing anorexia and cachexia
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BCAAs are further depleted from the circulation due to increased uptake by skeletal muscles that use the BCAAs in the synthesis of glutamine, which is produced in order to clear the ammonia that is not cleared by the failing liver
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patients with chronic liver disease, particularly cirrhosis, routinely have decreased BCAAs and increased aromatic amino acids (AAAs) in their circulation
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Maintaining a higher serum albumin in patients with cirrhosis is associated with decreased mortality and improved quality of life
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the serum BCAA concentration is strongly correlated with the serum albumin level