A snack enriched with oral branched-chain amino acids prevents a fall in albumin in patients with liver cirrhosis undergoing chemoembolization for hepatocellular carcinoma
Introduction
Hepatocellular carcinoma (HCC) is the most common carcinoma worldwide [1]. Treatment differs depending on the stage and on liver function, with radiofrequency ablation, percutaneous ethanol injection therapy, hepatic resection, liver transplantation, and trans-arterial chemoembolization (TACE) all used as therapy for HCC [2]. All these modalities except for liver transplantation cause damage to the liver. Trans-arterial chemoembolization is widely used for treatment of distributed HCC, especially in patients who cannot undergo resection or radiofrequency ablation, and improves the prognosis of patients with unresectable HCC [3], [4]. However, development of liver cirrhosis (LC) is a major problem in patients with HCC [5]. Liver cirrhosis is characterized by protein-energy malnutrition consisting of impaired glycolysis and glycogenesis, a negative nitrogen balance, and hyperlipolysis [6], [7], [8]. Protein-energy malnutrition has a high morbidity and mortality due to an increased risk of life-threatening complications, which in turn reduces survival and quality of life (QOL) independent of liver function [9], [10]. Liver damage caused by HCC treatment can worsen malnutrition and may occasionally lead to development of ascites and icterus, which may be fatal [11], [12], [13]. However, avoidance of exacerbation of liver damage during TACE may lead to inadequate control of HCC.
Supplementation with branched-chain amino acids (BCAA) in patients with liver disease is receiving increasing attention. Administration of BCAA can correct malnutrition associated with LC in animals and humans [14], [15], and long-term nutritional BCAA supplementation may also be useful in prevention of hepatic failure while also improving surrogate markers in advanced LC [15], [16], [17]. The BCAA supplementation is also effective in down-regulating protein metabolism in LC with reduction of ammonia (NH3), thus improving the nitrogen balance and resulting in better clinical outcomes [15], [18], [19]. The mechanisms underlying the beneficial effects of BCAA might be mediated by stimulation of hepatocyte growth factor activity that induces liver regeneration [20]. Therefore, nutritional support may play an important role in management of LC in unresectable HCC, but there have been few studies on oral BCAA-enriched snack support in patients with LC undergoing TACE [21]. We hypothesized that short-term administration of BCAA will improve liver function and nutritional status in such patients. Therefore, the study was performed to examine whether short-term administration of BCAA from 1 day before TACE could help to improve liver function and nutritional status in patients with HCC during the perioperative period.
Section snippets
Subjects
The subjects were 56 patients (40 men and 16 women) who underwent TACE for HCC between 2004 and 2005 at Nagasaki University Hospital (Table 1). All patients were Japanese and had LC that was diagnosed based on laboratory data. Diagnosis of HCC was based on findings in contrast-enhanced computed tomography scans and hepatic-artery angiography. No patients had vessel invasion at the time of entry into the study, and none had been prescribed BCAA supplements before TACE. All subjects provided
Results
The 56 patients were randomly placed into the BCAA (n = 28) and control (n = 28) groups. The baseline clinical characteristics of the patients are shown in Table 1. There was no difference in Child-Pugh score between the 2 groups, but albumin, BTR, ChE, TC, and blood cell counts in the BCAA group were lower than in the control group, and TB in the BCAA group was higher than in the control group. The duration of hospitalization did not differ significantly between the groups, and no TACE-related
Discussion
Our results show that oral consumption of a BCAA-enriched LES for 14 days decreased the loss of TP and albumin and reduced suppression of liver function due to TACE in patients with LC associated with HCC. These beneficial results occurred within a short time after TACE but did not affect overall survival time. An effect of long-term BCAA administration in patients undergoing chemoembolization for HCC has been reported, but it was unclear whether short-term BCAA intake could improve the
Acknowledgment
The authors thank all the participants and staff for their roles in this study, with special appreciation to Hisato Nagaoka.
References (34)
- et al.
Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma
Hepatology
(2002) - et al.
Arterial embolization or chemoembolization versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomized controlled trial
Lancet
(2002) Primary hepatocellular carcinoma—etiology, pathogenesis, and prevention
Hum Pathol
(1981)- et al.
Body composition in nonalcoholic cirrhosis: the effect of disease etiology and severity on nutritional compartments
Gastroenterology
(1994) - et al.
Primary treatment of hepatocellular carcinoma by arterial chemoembolization
Am J Surg
(1992) - et al.
Long-term oral branched-chain amino acid treatment in chronic hepatic encephalopathy: a randomized double blind casein-controlled trial
J Hepatol
(1990) - et al.
BCAA-enriched snack improves nutritional state of cirrhosis
Nutrition
(2007) - et al.
Significance of branched chain amino acids as possible stimulators of hepatocyte growth factor
Biochem Biophys Res Commun
(2004) - et al.
Effect of a late evening snack on the blood glucose level and energy metabolism in patients with liver cirrhosis
Hepatol Res
(2003) - et al.
The effect of late evening snack in patients with liver cirrhosis
Hepatol Res
(2005)