Branched-chain amino acids supplementation has beneficial effects on the progression of liver cirrhosis: A meta-analysis

Jia-Yu Du; Liu Shu; Yu-Tian Zhou; Li Zhang

doi:10.12998/wjcc.v10.i30.10984

Branched-chain amino acids supplementation has beneficial effects on the progression of liver cirrhosis: A meta-analysis

World J Clin Cases. 2022 Oct 26;10(30):10984-10996. doi: 10.12998/wjcc.v10.i30.10984.

Authors

Jia-Yu Du¹, Liu Shu², Yu-Tian Zhou³, Li Zhang⁴

Affiliations

¹ School of Clinical Medicine, Chengdu Medical College, Chengdu 610000, Sichuan Province, China.
² Department of Neuroscience, College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China.
³ Department of Geriatrics, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 610000, Sichuan Province, China.
⁴ Department of Geriatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu 610072, Sichuan Province, China. zhangligbyl@med.uestc.edu.cn.

Abstract

Background: Liver cirrhosis (LC) is currently the 11^th most common cause of death and 15^th cause of morbidity globally. The treatment of LC is mainly aimed at etiological intervention, lifestyle intervention, prevention and treatment of complications and nutritional treatment. Nutritional treatment of LC mainly includes increasing dietary intake, food intake time and branched-chain amino acids (BCAAs). Despite the recommendation of BCAAs in some guidelines, adverse effects have been reported in studies so the efficacy and safety of BCAAs remain controversial. Currently, BCAAs have been widely used in chronic liver disease, while the summary of the effect of BCAAs on long-term prognosis is rare.

Aim: To determine the effects of BCAAs in patients with LC.

Methods: The PubMed, Cochrane Library, Embase and Web of Science databases were searched. The retrieval deadline was 1 October 2021 and there were no language restrictions set in the retrieval. The study was performed in strict accordance with the inclusion and exclusion criteria. Nine studies were finally included. The primary outcome was complications of LC. The secondary outcomes were nutritional status and liver function. This meta-analysis used the Review Manager, version 5 statistical package (Cochrane Collaboration, Oxford, England) for analysis.

Results: The analysis included nine studies that consisted of 1080 patients (554 in the BCAA groups and 526 in the control groups). The nine studies were randomized control trials (RCTs). The quality of the studies was assessed using the risk of bias method recommended by the Cochrane Collaboration. BCAAs reduced the rate of complications in LC patients [Risk ratio: 0.70, 95% confidence interval (CI): 0.56-0.88, P = 0.002] and improved patients' albumin levels [std mean difference SMD: 0.26, 95%CI: 0.12-0.40, P = 0.0002]. Meanwhile, BCAAs significantly ameliorated the levels of alanine transaminase (SMD: -2.03, 95%CI: -2.52 to -1.53, P < 0.00001) and aspartate aminotransferase (SMD: -1.8, 95%CI: -2.14 to -1.46, P < 0.00001). Meanwhile, glucose in the LC was significantly increased in BCAA-treated patients (MD: 13.04, 95%CI: 6.81-19.89, P = 0.0002).

Conclusion: BCAAs reduce the incidence of complications in patients with LC and ameliorate nutritional status.

Keywords: Branched-chain amino acids; Complications; Glucose; Liver cirrhosis; Liver function; Nutrition.