O045 - BRANCHED CHAIN AMINO ACIDS IMPROVE MUSCLE MASS AND FUNCTION COMPARED TO WHEY PROTEIN IN LIVER CIRRHOSIS: A RANDOMIZED CONTROLLED TRIAL

O045

BRANCHED CHAIN AMINO ACIDS IMPROVE MUSCLE MASS AND FUNCTION COMPARED TO WHEY PROTEIN IN LIVER CIRRHOSIS: A RANDOMIZED CONTROLLED TRIAL

J. Benjamin^1,*, P. B. Kapoor¹, C. Vashistha², K. Bansal ¹, R. Maiwall ², G. Kumar ³, A. Saraya ¹, Y. K. Joshi¹, S. K. Sarin²

¹ Clinical Nutrition , ²Hepatology , ³ Biostatistics, Institute of Liver and Biliary Sciences , New Delhi , India

Rationale: For the treatment of muscle loss, and poor muscle function nutritional supplements are prescribed to patients with liver cirrhosis (LC). Comparison of whey protein (WP) with branched chain amino acids (BCAA) lacks substantiation from randomized controlled trials.

Aim: To compare the effect of WP and BCAA on muscle mass, muscle function, markers of muscle regeneration and health related quality of life (HRQoL).

Methods: Sixty two patients were randomized to WP and BCAA groups, receiving 16gm/day of oral BCAA or WP powders in addition to 35 Kcal and 1.35 gm protein/kg wt diet, for 3 mo. Patients were followed-up to collect clinical, nutritional and biochemical details. Appendicular skeletal muscle mass (ASMM) was assessed by DEXA. Muscle performance by 6 minute walk distance (6MWD), and liver frailty index (LFI), and HRQoL by Chronic Liver Disease Questionnaire, Serum IGF1 and myostatin levels by ELISA. 

Results: Eligible patients with cirrhosis (n=62) [age: 47.3±10.2 years, male (100%), etiology: (Alcohol: Cryptogenic: NASH: Others = 60%:22%:8%:10%), BMI: 20.8±2.1 (kg/m²), CTP 7.9±0.8] were randomized to WP (n=31) and BCAA (n=31) groups. 42 completed intervention, and analyzed as per-protocol. At 3 mo, ASMM improved in 26 (62%); WP 10(48%) vs. BCAA 16(76%) groups, p=0.045. From baseline to 3 mo (WP vs. BCAA), [ASMM(Kg): 17.6± 2.8 to 18.7± 3, p=0.07, vs. 16.5± 2 to 17.4± 2.8, p=0.045], [6MWD(m): 441±73 to 456±71, p=0.107 vs. 417±63 to 445±53, p=0.027]; [IGF1(ng/ml): 1.8(1.56-6.25) to 2.1(1.35-5), p=0.09; vs. 1.72 (1.56-7.28) to 2.2(1.56-9.75), p=0.006], [myostatin(ng/ml): 8.2±2.3 to 9.2±2.3, p=0.038 vs. 9.0±2.1 to 9.3±3, p=0.261]. CTP score, LFI and HRQoL improved significantly in both groups. 

Conclusion:  Supplementation of BCAA is better than WP in improving muscle mass, function and IGF1 in cirrhosis.

Disclosure of Interest: None declared