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Nathan Goodyear

Branched Chain Amino Acid Supplementation for Patients with Cirrhosis | Clinical Correl... - 0 views

  • low level of BCAAs in patients with cirrhosis is hypothesized to be one of multiple factors responsible for development of hepatic encephalopathy
  • 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
  • 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
  • Malnutrition can be mitigated with BCAA supplementation
  • 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
  • Leucine has been shown to be the most effective of the BCAAs because it acts via multiple pathways to stimulate protein synthesis
  • BCAAs metabolites inhibit proteolysis
  • Patients with cirrhosis have both insulin deficiency and insulin resistance
  • 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
  • Coadministration of BCAAs and glucose has been found to be particularly useful
  • BCAA supplementation improves protein-energy malnutrition by improving utilization of glucose, thereby diminishing the drive for proteolysis, inhibiting protein breakdown, and stimulating protein synthesis
  • Cirrhotic patients have impaired immune defense, characterized by defective phagocytic activity and impaired intracellular killing activity
  • another effect of BCAA supplementation is improvement of phagocytic function of neutrophils and possibly improvement in natural killer T (NKT) cell lymphocyte activity
  • 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
  • BCAA administration has also been shown to have a positive effect on liver regeneration
  • 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
  • BCAAs activate rapamycin signaling pathways which promotes albumin synthesis in the liver as well as protein and glycogen synthesis in muscle tissue
  • Chemical improvement with BCAA treatment is demonstrated by recovery of serum albumin and lowering of serum bilirubin levels
  • 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
  • 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
  • Patients receiving BCAA supplementation also have a lower average hospital admission rate, better nutritional status, and better liver function tests
  • patients taking BCAA supplementation report improved quality of life
  • BCAAs have been shown to mitigate hepatic encephalopathy, cachexia, and infection rates, complications associated with the progression of hepatic cirrhosis
  • BCAAs make up 20-25% of the protein content of most foods
  • 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
  • In addition to BCAAs from diet, oral supplements of BCAAs can be used
  • 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
  • Coadministration of BCAAs with carnitine and zinc has also been shown to increase ammonia metabolism further reducing the encephalopathic symptoms
  • Cirrhotic patients benefit from eating frequent, small meals that prevent long fasts which place the patient in a catabolic state
  • the best time for BCAA supplementation is at bedtime to improve the catabolic state during starvation in early morning fasting
  • 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
  • Protein-energy malnutrition (PEM), with low serum albumin and low muscle mass, occurs in 65-90% of cases of advanced cirrhosis
  • hyperglucagonemia results in a catabolic state eventually producing anorexia and cachexia
  • 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
  • patients with chronic liver disease, particularly cirrhosis, routinely have decreased BCAAs and increased aromatic amino acids (AAAs) in their circulation
  • Maintaining a higher serum albumin in patients with cirrhosis is associated with decreased mortality and improved quality of life
  • the serum BCAA concentration is strongly correlated with the serum albumin level
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    great review of cirrhosis and BCCA supplementation.
Nathan Goodyear

Malnutrition and Clinical Outcomes: The Case for Medical Nutrition Therapy - ScienceDirect - 0 views

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    40-55% of adults hospitalized found to be malnourished or at risk for malnutrition with a whopping 12% severely malnourished.
Nathan Goodyear

Severe Starvation-Induced Hepatocyte Autophagy as a Cause of Acute Liver Injury in Anor... - 0 views

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    extreme malnutrition as in anorexia is found to be associated with increased liver enzymes.
Nathan Goodyear

Understanding the Role of Nutrition and Wound HealingNutrition in Clinical Practice - J... - 0 views

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    Malnutrition linked to poor wound healing, decreased wound tensile strength, and increased infection rates.
Nathan Goodyear

Preoperative parenteral nutrition of malnourished surgical patients. - PubMed - NCBI - 0 views

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    malnutrition is associated with increased surgical complication and mortality risk; IV decreased complications and mortality
Nathan Goodyear

Immunonutrition in Surgical Patients: Ingenta Connect - 0 views

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    Malnutrition is associated with increased surgical risk and poor outcomes. The authors support IV preoperative nutrition at least 10 days prior to surgery and for 7 days post surgery.  This therapy reduced inflammation and oxidative stress.
Nathan Goodyear

PLOS ONE: Telomerase Reverse Transcriptase Synergizes with Calorie Restriction to Incre... - 0 views

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    calorie restriction, though not malnutrition, is associated with longevity as determined by increased telomerase reverse transcriptase and a reduction in aged related diseases.  Granted this was a mouse model.
Nathan Goodyear

Bariatric Surgery Results in Cortical Bone Loss - 0 views

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    no surprise here.  Bariatric surgery was found to result in bone loss.  Disruption of the GI tract and absorption is going to result in malnutrition states and bone loss will be one of the side effects.
Nathan Goodyear

Effect of long-term oral supplementation with branched-chain amino acid granules on the... - 0 views

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    long term BCAA supplementation (defined as > 6 months) shown to be safe and effective in liver cirrhosis malnutrition, liver failure and hepatic encephalopathy.
Nathan Goodyear

Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a do... - 0 views

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    BCAA beneficial in malnutrition, anorexia, and QOL measures in patients with liver failure.
fnfdoc

How Bad Vitamin B12 Deficiency | Your Health Our Priority - 0 views

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    Vitamin b12 called cobalamine, important for vital functions in body, like maintenance. Deficiency cause malnutrition and digestion problems. Treatments including supplements, injections and vitamins regulatory measures.
Nathan Goodyear

Prevalence and Predictors of Abnormal Liver Enzymes in Young Women with Anorexia Nervosa - 0 views

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    liver enzymes inversely associated with body fat in women with anorexia.
Nathan Goodyear

[Protein catabolism and malnutrition in liver cirrhosis - impact of oral nutritional th... - 0 views

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    Patients with liver cirrhosis will have low BCAA and thus supplementation proves to improve survival and QOL measures.
Nathan Goodyear

Parenteral nutrition in obstetric patients. [Nutr Clin Pract. 1990] - PubMed result - 0 views

  • Sufficient favorable clinical experience over the last 10 years suggests that PN is a relatively safe and effective method for reversing maternal malnutrition and promoting normal fetal growth and development.
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    IV nutritional therapy shown to be safe 
Nathan Goodyear

Deficiencies-graph.png 557×349 pixels - 0 views

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    RDA is not a great measure of individual nutrient need, but here is a 2009 USDA analysis of people not even meeting RDA.
Nathan Goodyear

The American Nutrient Gap: And How Vitamin and Mineral Supplements Can Help Fill It | M... - 0 views

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    Very insightful analysis:  A 2016 finds that estimated average requirements alone EAR and multivitamin/mineral supplement with food does not meed daily requirement.  EAR is much higher value than RDA.
digitalorainfo

Happiness Ville Foundation - 0 views

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    We, a young, dynamic and public-spirited team of activists at Happiness Ville, are constantly brainstorming ideas and ways to bring about the change we always talk about and hardly put into action. Our aim is to eradicate the 'mal' out of malnutrition, 'ill' out of the illiteracy, 'in' out of the injustice and the 'issues' out of the environment.
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