Chulabhorn International College of Medicine, Thammasat University, Pathum Thani, Thailand.
Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand.
BMC Gastroenterol. 2023 May 15;23(1):154. doi: 10.1186/s12876-023-02789-1.
Physical frailty is related with morbidity and mortality in patients with cirrhosis. Currently, there is no approved treatment of frailty in these patients. Here, we evaluated the efficacy of 16 weeks branched-chain amino acids (BCAA) supplementation on frailty in frail compensated cirrhotic patients.
After a 4-week run-in period consisted of dietary and exercise counseling, compensated cirrhotic patients with frailty, defined by liver frailty index (LFI)≥4.5, were randomly assigned (1:1) to BCAA or control group. The BCAA group received twice daily BCAAs supplementation (210 kcal, protein 13.5 g, BCAA 2.03 g) for 16 weeks. The primary outcome was frailty reversion. The secondary outcomes were changes in biochemistries, body composition evaluated by bioelectrical impedance analysis, and quality of life (QoL).
54 patients were prospectively enrolled (age 65.5 ± 9.9 years, 51.9% female, Child-Pugh A/B 68.5%/31.5%, MELD 10.3 ± 3.1). Baseline characteristics were similar between both groups. At week 16, BCAA group had a significant improvement in LFI (-0.36 ± 0.3 vs. -0.15 ± 0.28, P = 0.01), BMI (+ 0.51 ± 1.19 vs. -0.49 ± 1.89 kg/m, P = 0.03), and serum albumin (+ 0.26 ± 0.27 vs. +0.06 ± 0.3 g/dl, P = 0.01). The proportion of frailty reversion at week 16 was significantly higher in BCAA group (36% vs. 0%, P < 0.001). Compared with baseline, BCAA group had a significant increase in skeletal muscle index (7.5 ± 1.6 to 7.8 ± 1.5 kg/m, P = 0.03). Regarding the QoL, only the BCAA group had a significant improvement in all 4 domains of physical component score of the SF-36 questionnaire.
A 16-week BCAA supplementation improved frailty in frail compensated cirrhotic patients. In addition, this intervention resulted in an improvement of muscle mass and physical domain of QoL in these patients.
This study was registered with Thai Clinical Trial Registry (TCTR20210928001; https://www.thaiclinicaltrials.org/# ).
身体虚弱与肝硬化患者的发病率和死亡率有关。目前，尚无针对这些患者虚弱的经批准的治疗方法。在这里，我们评估了 16 周支链氨基酸（BCAA）补充剂对虚弱代偿性肝硬化患者虚弱的疗效。
在包括饮食和运动咨询的 4 周导入期后，根据肝虚弱指数（LFI）≥4.5，将虚弱的代偿性肝硬化患者（LFI）随机分为（1：1）BCAA 组或对照组。BCAA 组每天接受两次 BCAA 补充剂（210 卡路里，蛋白质 13.5 克，BCAA 2.03 克），持续 16 周。主要结局是虚弱逆转。次要结局是生化指标、生物电阻抗分析评估的身体成分以及生活质量（QoL）的变化。
前瞻性纳入 54 例患者（年龄 65.5±9.9 岁，51.9%女性，Child-Pugh A/B 68.5%/31.5%，MELD 10.3±3.1）。两组的基线特征相似。在第 16 周时，BCAA 组的 LFI 显著改善（-0.36±0.3 与-0.15±0.28，P=0.01），BMI（+0.51±1.19 与-0.49±1.89 kg/m，P=0.03）和血清白蛋白（+0.26±0.27 与+0.06±0.3 g/dl，P=0.01）。第 16 周时，BCAA 组虚弱逆转的比例明显更高（36%与 0%，P<0.001）。与基线相比，BCAA 组骨骼肌指数显著增加（7.5±1.6 至 7.8±1.5 kg/m，P=0.03）。关于生活质量，只有 BCAA 组在 SF-36 问卷的所有 4 个身体成分评分领域均有显著改善。
16 周的 BCAA 补充剂改善了虚弱代偿性肝硬化患者的虚弱状况。此外，该干预措施还改善了这些患者的肌肉质量和身体领域的生活质量。
该研究已在泰国临床试验注册处（TCTR20210928001；https://www.thaiclinicaltrials.org/#）注册。
