Department of Medicine, The University of Melbourne, Parkville, Victoria, Australia.
Department of Gastroenterology, Austin Health, Heidelberg, Victoria, Australia.
Aliment Pharmacol Ther. 2024 Apr;59(8):941-952. doi: 10.1111/apt.17917. Epub 2024 Feb 26.
Sarcopenia is associated with adverse outcomes in cirrhosis. Branched-chain amino acids (BCAA) target several pathways that lead to muscle loss in this population.
We aimed to evaluate the impact of BCAA supplementation on sarcopenia measures in patients with cirrhosis.
We conducted a 12-month double-blinded, randomised, controlled trial of BCAA supplementation (30 g daily) compared to an equicaloric, equi-nitrogenous whey protein in volunteers with cirrhosis and reduced muscle strength. The primary endpoint was an increase in grip strength and upper limb lean mass measured on DEXA. Mean-adjusted differences (MAD, 95% CI) between groups at 6 and 12 months are reported as treatment effect using a linear mixed model for repeated measures.
A total of 150 volunteers entered the trial (74 BCAA, 76 control), with a median age of 58 years [IQR 48; 63] and MELD of 14 [12; 17]. At 12 months, 57% in the BCAA arm and 61% in the control arm met the primary endpoint (p = 0.80). No significant between-group difference was found in grip strength (MAD -0.15 kg [-0.37; 0.06], p = 0.29) or upper limb lean mass (1.7 kg [-0.2; 3.6], p = 0.22) at 12 months. No significant differences in other body composition parameters, physical performance, frailty, rates of hospitalisation or mortality were found between the BCAA and the control group. Fatigue improved across the entire cohort, without significant between-group differences. 15% of volunteers reported side effects, with distaste higher in the BCAA arm (p = 0.045).
BCAA supplementation did not improve measures of muscle strength, mass or performance or physical frailty compared to a whey protein supplement in a randomised controlled setting. ACTRN12618000802202.
肌肉减少症与肝硬化的不良结局相关。支链氨基酸（BCAA）针对导致该人群肌肉丧失的多种途径。
我们旨在评估 BCAA 补充剂对肝硬化患者肌肉减少症措施的影响。
我们进行了一项为期 12 个月的双盲、随机、对照试验，比较了支链氨基酸（30g/天）补充剂与等热量、等氮乳清蛋白对肌肉力量减弱的肝硬化志愿者的影响。主要终点是通过 DEXA 测量握力和上肢瘦体重的增加。使用重复测量线性混合模型报告 6 个月和 12 个月时组间的平均调整差异（MAD，95%CI）作为治疗效果。
共有 150 名志愿者参加了试验（74 名 BCAA，76 名对照组），中位年龄为 58 岁[IQR 48；63]，MELD 为 14[12；17]。在 12 个月时，BCAA 组 57%和对照组 61%达到主要终点（p=0.80）。在 12 个月时，握力（MAD-0.15kg[-0.37；0.06]，p=0.29）或上肢瘦体重（1.7kg[-0.2；3.6]，p=0.22）无显著组间差异。两组之间在其他身体成分参数、身体表现、虚弱程度、住院率或死亡率方面没有发现显著差异。整个队列的疲劳均有所改善，且无显著组间差异。15%的志愿者报告有副作用，BCAA 组的不良反应更高（p=0.045）。
与乳清蛋白补充剂相比，BCAA 补充剂在随机对照环境中不能改善肌肉力量、质量或表现或身体虚弱程度。ACTRN12618000802202。
