Mizubuti Y G G, Vieira E L M, Silva T A, d'Alessandro M O, Generoso S V, Teixeira A L, Lima A S, Correia M I T D
Department of Surgery, University Hospital Liver Disease Program, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais30130-100, Brazil.
Department of Nutrition, Pontifícia Universidade Católica-PUC, Barreiro Unit, Belo Horizonte, Minas Gerais30640-070, Brazil.
Br J Nutr. 2021 Apr 14;125(7):768-779. doi: 10.1017/S0007114520003219. Epub 2020 Aug 18.
Protein supplementation may be beneficial for patients with chronic liver disease (CLD). This study compared the effects of whey protein isolate (WP) and casein (CA) supplementation on nutritional status and immune parameters of CLD patients who were randomly assigned to take 20 g of WP or CA twice per d as a supplement for 15 d. Body composition, muscle functionality and plasmatic immunomarkers were assessed before and after supplementation. Patients were also classified according to the model for end-stage liver disease (MELD) into less (MELD < 15) and more (MELD ≥ 15) severe disease groups. Malnutrition, determined by the Subjective Global Assessment at baseline, was observed in 57·4 % and 54·2 % of patients in the WP and CA groups, respectively ( = 0·649). Protein intake was lower at baseline in the WP group than in the CA group ( = 0·035), with no difference after supplementation ( = 0·410). Both the WP and CA MELD < 15 groups increased protein intake after supplementation according to the intragroup analysis. No differences were observed in body composition, muscle functionality, most plasma cytokines (TNF, IL-6, IL-1 and interferon-), immunomodulatory proteins (sTNFR1, sTNFR2, brain-derived neurotrophic factor and glial cell line-derived neurotrophic factor) or immunomodulatory hormones (adiponectin, insulin and leptin) after supplementation in the WP groups at the two assessed moments. WP supplementation increased the levels of interferon-γ-induced protein-10/CXCL10 ( = 0·022), eotaxin-1/CCL11 ( = 0·031) and monocyte chemoattractant protein-1/CCL2 ( = 0·018) and decreased IL-5 ( = 0·027), including among those in the MELD ≥ 15 group, for whom IL-10 was also increased ( = 0·008). Thus, WP consumption by patients with CLD impacted the immunomodulatory responses when compared with CA with no impact on nutritional status.
蛋白质补充剂可能对慢性肝病（CLD）患者有益。本研究比较了补充乳清分离蛋白（WP）和酪蛋白（CA）对CLD患者营养状况和免疫参数的影响，这些患者被随机分配每天两次服用20克WP或CA作为补充剂，持续15天。在补充前后评估身体成分、肌肉功能和血浆免疫标志物。患者还根据终末期肝病模型（MELD）分为病情较轻（MELD<15）和病情较重（MELD≥15）两组。根据基线时的主观全面评估确定，WP组和CA组分别有57.4%和54.2%的患者存在营养不良（P=0.649）。WP组基线时的蛋白质摄入量低于CA组（P=0.035），补充后无差异（P=0.410）。根据组内分析，WP组和CA组中MELD<15的两组补充后蛋白质摄入量均增加。在两个评估时间点，WP组补充后，身体成分、肌肉功能、大多数血浆细胞因子（TNF、IL-6、IL-1和干扰素-γ）、免疫调节蛋白（sTNFR1、sTNFR2、脑源性神经营养因子和胶质细胞源性神经营养因子）或免疫调节激素（脂联素胰岛素和瘦素）均未观察到差异。补充WP可增加干扰素-γ诱导蛋白-10/CXCL10（P=0.022）、嗜酸性粒细胞趋化因子-1/CCL11（P=0.031）和单核细胞趋化蛋白-1/CCL2（P=0.018）的水平，并降低IL-5（P=0.027），在MELD≥15组中也是如此，该组中IL-10也增加（P=0.008）。因此，与CA相比，CLD患者食用WP会影响免疫调节反应，而对营养状况无影响。
