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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	HMB hydroxymethylbutyrate clinical trial PCA Nutrition. Foods and food supply TX341-641
Acceso en línea:	https://doaj.org/article/bceaefe8a6ae454fb1e481e9a14d8381
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spelling	oai:doaj.org-article:bceaefe8a6ae454fb1e481e9a14d83812021-11-25T18:33:51ZAmino Acid Profile in Malnourished Patients with Liver Cirrhosis and Its Modification with Oral Nutritional Supplements: Implications on Minimal Hepatic Encephalopathy10.3390/nu131137642072-6643https://doaj.org/article/bceaefe8a6ae454fb1e481e9a14d83812021-10-01T00:00:00Zhttps://www.mdpi.com/2072-6643/13/11/3764https://doaj.org/toc/2072-6643Low 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.Silvia EspinaYolanda Gonzalez-IrazabalAlejandro Sanz-ParisMarta Lopez-YusMaria Pilar Garcia-SobrevielaRaquel del Moral-BergosBeatriz Garcia-RodriguezJavier Fuentes-OlmoVanesa Bernal-MonterdeJose M. Arbones-MainarMDPI AGarticleHMBhydroxymethylbutyrateclinical trialPCANutrition. Foods and food supplyTX341-641ENNutrients, Vol 13, Iss 3764, p 3764 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	HMB hydroxymethylbutyrate clinical trial PCA Nutrition. Foods and food supply TX341-641
spellingShingle	HMB hydroxymethylbutyrate clinical trial PCA Nutrition. Foods and food supply TX341-641 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
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.
format	article
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
title	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_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_sort	amino acid profile in malnourished patients with liver cirrhosis and its modification with oral nutritional supplements: implications on minimal hepatic encephalopathy
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/bceaefe8a6ae454fb1e481e9a14d8381
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Amino Acid Profile in Malnourished Patients with Liver Cirrhosis and Its Modification with Oral Nutritional Supplements: Implications on Minimal Hepatic Encephalopathy

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