Ruiz-Margáin A, Macías-Rodríguez R U, Ríos-Torres S L, Román-Calleja B M, Méndez-Guerrero O, Rodríguez-Córdova P, Torre A
Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
Departamento de Gastroenterología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México.
Rev Gastroenterol Mex (Engl Ed). 2018 Jan-Mar;83(1):9-15. doi: 10.1016/j.rgmx.2017.02.005. Epub 2017 Apr 11.
The potential benefits of branched-chain amino acids (BCAAs) in cirrhosis extend beyond just the improvement of nutritional status. Their effects include improvement of glucose tolerance, oxidative stress, and inflammatory markers, as has been shown in several studies. A dual nutritional approach of a high-protein, high-fiber diet plus BCAAs in cirrhosis could have additional benefits, compared with BCAAs alone. Such an approach has not been explored and therefore the aim of the present study was to evaluate the effect of a combination of a high-protein, high-fiber diet plus BCAA supplementation over a 6-month period of time on the nutritional status of patients with cirrhosis, as well as its safety and tolerability for those same patients.
An open, randomized clinical trial was conducted. Patients were randomized to one of two groups: the BCAAs+HPHF diet intervention group: a high-protein, high-fiber diet with 1.2g/kg protein and 30g of fiber plus supplementation with oral branched-chain amino acids 110g daily and the HPHF diet control group: a high-protein, high-fiber diet with 1.2g/kg protein and 30g of fiber. The differences between the treatment groups were compared using the unpaired T test and the differences at the end of treatment were compared using the paired T test.
A total of 72 patients were included, 37 in the intervention group and 35 in the control group. At the end of the study period, ammonia and glucose levels showed no significant increase in either group, reflecting the safety of the BCAA supplement. Furthermore, muscle and fat mass were evaluated through triceps skinfold thickness and mid-arm muscle circumference measurements. There was an increase in muscle mass and a decrease in fat mass in the BCAA group, but not in the control group. After the intervention, there were no significant changes in the Psychometric Hepatic Encephalopathy Score or the Critical Flicker Frequency score results in either group, and no episodes of hepatic encephalopathy were observed during the treatment period.
Supplementation with branched-chain amino acids plus a high-fiber, high-protein diet is a safe intervention in patients with cirrhosis. It helps increase muscle mass and does not raise the levels of ammonia or glucose, nor is it associated with the development of hepatic encephalopathy.
支链氨基酸（BCAAs）在肝硬化治疗中的潜在益处不仅限于改善营养状况。多项研究表明，其作用还包括改善葡萄糖耐量、氧化应激和炎症标志物。与单独使用BCAAs相比，在肝硬化患者中采用高蛋白、高纤维饮食加BCAAs的双重营养方法可能会带来更多益处。目前尚未对这种方法进行探索，因此本研究的目的是评估在6个月的时间里，高蛋白、高纤维饮食加BCAA补充剂的联合应用对肝硬化患者营养状况的影响，以及对这些患者的安全性和耐受性。
进行了一项开放、随机临床试验。患者被随机分为两组：BCAAs+HPHF饮食干预组：一种高蛋白、高纤维饮食，蛋白质含量为1.2g/kg，纤维含量为30g，外加每日口服110g支链氨基酸补充剂；HPHF饮食对照组：一种高蛋白、高纤维饮食，蛋白质含量为1.2g/kg，纤维含量为30g。使用不成对T检验比较治疗组之间的差异，使用配对T检验比较治疗结束时的差异。
共纳入72例患者，干预组37例，对照组35例。在研究期结束时，两组的氨和葡萄糖水平均未显著升高，这反映了BCAA补充剂的安全性。此外，通过肱三头肌皮褶厚度和上臂中部肌肉周长测量来评估肌肉和脂肪量。BCAA组的肌肉量增加，脂肪量减少，而对照组则没有。干预后，两组的心理测量肝性脑病评分或临界闪烁频率评分结果均无显著变化，且在治疗期间未观察到肝性脑病发作。
补充支链氨基酸加高蛋白、高纤维饮食对肝硬化患者是一种安全的干预措施。它有助于增加肌肉量，不会提高氨或葡萄糖水平，也与肝性脑病的发生无关。
