Amino Acid Profile in Malnourished Patients with Liver Cirrhosis and Its Modification with Oral Nutritional Supplements: Implications on Minimal Hepatic Encephalopathy
Low plasma levels of branched chain amino acids (BCAA) in liver cirrhosis are associated with hepatic encephalopathy (HE). We aimed to identify a metabolic signature of minimal hepatic encephalopathy (MHE) in malnourished cirrhotic patients and evaluate its modification with oral nutritional supplem...
| Main Authors: | , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2021-10-01
|
| Series: | Nutrients |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2072-6643/13/11/3764 |
| _version_ | 1797509028814782464 |
|---|---|
| author | Silvia Espina Yolanda Gonzalez-Irazabal Alejandro Sanz-Paris Marta Lopez-Yus Maria Pilar Garcia-Sobreviela Raquel del Moral-Bergos Beatriz Garcia-Rodriguez Javier Fuentes-Olmo Vanesa Bernal-Monterde Jose M. Arbones-Mainar |
| author_facet | Silvia Espina Yolanda Gonzalez-Irazabal Alejandro Sanz-Paris Marta Lopez-Yus Maria Pilar Garcia-Sobreviela Raquel del Moral-Bergos Beatriz Garcia-Rodriguez Javier Fuentes-Olmo Vanesa Bernal-Monterde Jose M. Arbones-Mainar |
| author_sort | Silvia Espina |
| collection | DOAJ |
| description | Low plasma levels of branched chain amino acids (BCAA) in liver cirrhosis are associated with hepatic encephalopathy (HE). We aimed to identify a metabolic signature of minimal hepatic encephalopathy (MHE) in malnourished cirrhotic patients and evaluate its modification with oral nutritional supplements (ONS) enriched with ß-Hydroxy-ß-methylbutyrate (HMB), a derivative of the BCAA leucine. Post hoc analysis was conducted on a double-blind placebo-controlled trial of 43 individuals with cirrhosis and malnutrition, who were randomized to receive, for 12 weeks, oral supplementation twice a day with either 220 mL of Ensure<sup>®</sup> Plus Advance (HMB group, <i>n</i> = 22) or with 220 mL of Ensure<sup>®</sup> Plus High Protein (HP group, <i>n</i> = 21). MHE evaluation was by psychometric hepatic encephalopathy score (PHES). Compared to the HP group, an HMB-specific treatment effect led to a larger increase in Val, Leu, Phe, Trp and BCAA fasting plasma levels. Both treatments increased Fischer’s ratio and urea without an increase in Gln or ammonia fasting plasma levels. MHE was associated with a reduced total plasma amino acid concentration, a reduced BCAA and Fischer´s ratio, and an increased Gln/Glu ratio. HMB-enriched ONS increased Fischer´s ratio without varying Gln or ammonia plasma levels in liver cirrhosis and malnutrition, a protective amino acid profile that can help prevent MHE. |
| first_indexed | 2024-03-10T05:12:10Z |
| format | Article |
| id | doaj.art-bceaefe8a6ae454fb1e481e9a14d8381 |
| institution | Directory Open Access Journal |
| issn | 2072-6643 |
| language | English |
| last_indexed | 2024-03-10T05:12:10Z |
| publishDate | 2021-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Nutrients |
| spelling | doaj.art-bceaefe8a6ae454fb1e481e9a14d83812023-11-23T00:45:34ZengMDPI AGNutrients2072-66432021-10-011311376410.3390/nu13113764Amino Acid Profile in Malnourished Patients with Liver Cirrhosis and Its Modification with Oral Nutritional Supplements: Implications on Minimal Hepatic EncephalopathySilvia Espina0Yolanda Gonzalez-Irazabal1Alejandro Sanz-Paris2Marta Lopez-Yus3Maria Pilar Garcia-Sobreviela4Raquel del Moral-Bergos5Beatriz Garcia-Rodriguez6Javier Fuentes-Olmo7Vanesa Bernal-Monterde8Jose M. Arbones-Mainar9Gastroenterology Department, University Hospital Miguel Servet, 50009 Zaragoza, SpainInstituto de Investigación Sanitaria (IIS) Aragon, 50009 Zaragoza, SpainInstituto de Investigación Sanitaria (IIS) Aragon, 50009 Zaragoza, SpainInstituto de Investigación Sanitaria (IIS) Aragon, 50009 Zaragoza, SpainInstituto de Investigación Sanitaria (IIS) Aragon, 50009 Zaragoza, SpainInstituto de Investigación Sanitaria (IIS) Aragon, 50009 Zaragoza, SpainInstituto de Investigación Sanitaria (IIS) Aragon, 50009 Zaragoza, SpainGastroenterology Department, University Hospital Miguel Servet, 50009 Zaragoza, SpainGastroenterology Department, University Hospital Miguel Servet, 50009 Zaragoza, SpainInstituto de Investigación Sanitaria (IIS) Aragon, 50009 Zaragoza, SpainLow plasma levels of branched chain amino acids (BCAA) in liver cirrhosis are associated with hepatic encephalopathy (HE). We aimed to identify a metabolic signature of minimal hepatic encephalopathy (MHE) in malnourished cirrhotic patients and evaluate its modification with oral nutritional supplements (ONS) enriched with ß-Hydroxy-ß-methylbutyrate (HMB), a derivative of the BCAA leucine. Post hoc analysis was conducted on a double-blind placebo-controlled trial of 43 individuals with cirrhosis and malnutrition, who were randomized to receive, for 12 weeks, oral supplementation twice a day with either 220 mL of Ensure<sup>®</sup> Plus Advance (HMB group, <i>n</i> = 22) or with 220 mL of Ensure<sup>®</sup> Plus High Protein (HP group, <i>n</i> = 21). MHE evaluation was by psychometric hepatic encephalopathy score (PHES). Compared to the HP group, an HMB-specific treatment effect led to a larger increase in Val, Leu, Phe, Trp and BCAA fasting plasma levels. Both treatments increased Fischer’s ratio and urea without an increase in Gln or ammonia fasting plasma levels. MHE was associated with a reduced total plasma amino acid concentration, a reduced BCAA and Fischer´s ratio, and an increased Gln/Glu ratio. HMB-enriched ONS increased Fischer´s ratio without varying Gln or ammonia plasma levels in liver cirrhosis and malnutrition, a protective amino acid profile that can help prevent MHE.https://www.mdpi.com/2072-6643/13/11/3764HMBhydroxymethylbutyrateclinical trialPCA |
| spellingShingle | Silvia Espina Yolanda Gonzalez-Irazabal Alejandro Sanz-Paris Marta Lopez-Yus Maria Pilar Garcia-Sobreviela Raquel del Moral-Bergos Beatriz Garcia-Rodriguez Javier Fuentes-Olmo Vanesa Bernal-Monterde Jose M. Arbones-Mainar Amino Acid Profile in Malnourished Patients with Liver Cirrhosis and Its Modification with Oral Nutritional Supplements: Implications on Minimal Hepatic Encephalopathy Nutrients HMB hydroxymethylbutyrate clinical trial PCA |
| title | Amino Acid Profile in Malnourished Patients with Liver Cirrhosis and Its Modification with Oral Nutritional Supplements: Implications on Minimal Hepatic Encephalopathy |
| title_full | Amino Acid Profile in Malnourished Patients with Liver Cirrhosis and Its Modification with Oral Nutritional Supplements: Implications on Minimal Hepatic Encephalopathy |
| title_fullStr | Amino Acid Profile in Malnourished Patients with Liver Cirrhosis and Its Modification with Oral Nutritional Supplements: Implications on Minimal Hepatic Encephalopathy |
| title_full_unstemmed | Amino Acid Profile in Malnourished Patients with Liver Cirrhosis and Its Modification with Oral Nutritional Supplements: Implications on Minimal Hepatic Encephalopathy |
| title_short | Amino Acid Profile in Malnourished Patients with Liver Cirrhosis and Its Modification with Oral Nutritional Supplements: Implications on Minimal Hepatic Encephalopathy |
| title_sort | amino acid profile in malnourished patients with liver cirrhosis and its modification with oral nutritional supplements implications on minimal hepatic encephalopathy |
| topic | HMB hydroxymethylbutyrate clinical trial PCA |
| url | https://www.mdpi.com/2072-6643/13/11/3764 |
| work_keys_str_mv | AT silviaespina aminoacidprofileinmalnourishedpatientswithlivercirrhosisanditsmodificationwithoralnutritionalsupplementsimplicationsonminimalhepaticencephalopathy AT yolandagonzalezirazabal aminoacidprofileinmalnourishedpatientswithlivercirrhosisanditsmodificationwithoralnutritionalsupplementsimplicationsonminimalhepaticencephalopathy AT alejandrosanzparis aminoacidprofileinmalnourishedpatientswithlivercirrhosisanditsmodificationwithoralnutritionalsupplementsimplicationsonminimalhepaticencephalopathy AT martalopezyus aminoacidprofileinmalnourishedpatientswithlivercirrhosisanditsmodificationwithoralnutritionalsupplementsimplicationsonminimalhepaticencephalopathy AT mariapilargarciasobreviela aminoacidprofileinmalnourishedpatientswithlivercirrhosisanditsmodificationwithoralnutritionalsupplementsimplicationsonminimalhepaticencephalopathy AT raqueldelmoralbergos aminoacidprofileinmalnourishedpatientswithlivercirrhosisanditsmodificationwithoralnutritionalsupplementsimplicationsonminimalhepaticencephalopathy AT beatrizgarciarodriguez aminoacidprofileinmalnourishedpatientswithlivercirrhosisanditsmodificationwithoralnutritionalsupplementsimplicationsonminimalhepaticencephalopathy AT javierfuentesolmo aminoacidprofileinmalnourishedpatientswithlivercirrhosisanditsmodificationwithoralnutritionalsupplementsimplicationsonminimalhepaticencephalopathy AT vanesabernalmonterde aminoacidprofileinmalnourishedpatientswithlivercirrhosisanditsmodificationwithoralnutritionalsupplementsimplicationsonminimalhepaticencephalopathy AT josemarbonesmainar aminoacidprofileinmalnourishedpatientswithlivercirrhosisanditsmodificationwithoralnutritionalsupplementsimplicationsonminimalhepaticencephalopathy |