Standard or Branched‐Chain Amino Acid Infusions as Short‐Term Nutritional Support in Liver Cirrhosis?

The metabolic effects of selected and branched‐chain amino acid (BCAA)‐enriched parenteral solutions were studied in liver cirrhosis. After 3 days of an oral protein‐free diet with balanced amino acid (AA) infusion, 36 cirrhotic patients without encephalopathy were randomly divided into four groups. Groups A and B were infused for 5 days with BCAA (valine, leucine, isoleucine) at doses of 0.5 and 1.0 g/kg/ day, respectively, as the only nitrogen source. Group C received 0.8 g/kg of essential and nonessential AA solution with a prevalence of BCAA; the last group (D) continued the basic standard diet, as control. Routine chemistry, urinary nitrogen losses, nitrogen balance, and the whole plasma AA pattern were detected before and after the treatment period. BCAA alone led to an impressive and significant improvement in the basic AA pattern in both the A and B groups. The same results were obtained in group C for plasma AA. In particular, the ratio of BCAA to aromatic amino acids in groups A, B, and C was significantly increased (p < 0.01, <0.02, <0.02, respectively). In group D the AA pattern and the BCAA/aromatic amino acid ratio remained unchanged. The negative nitrogen balance of the base state remained unchanged after 0.5 g of BCAA (A); it improved significantly and became positive during and after the infusions of a double dose of BCAA (B), as it did in the case of selective solutions (C), although to a lesser extent; the negative nitrogen balance of the control group showed only a slight improvement. The beneficial effects of BCAA in arousal from hepatic encephalopathy are well documented; the present study confirms the same beneficial effects on nutritional parameters. For these reasons, adequate doses of BCAA are highly recommended in the short‐term nutritional support of chronic and severe liver disease. (Journal of Parenteral and Enteral Nutrition 9 :447–451, 1985)