Meta-Analysis
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2022; 10(30): 10984-10996
Published online Oct 26, 2022. doi: 10.12998/wjcc.v10.i30.10984
Branched-chain amino acids supplementation has beneficial effects on the progression of liver cirrhosis: A meta-analysis
Jia-Yu Du, Liu Shu, Yu-Tian Zhou, Li Zhang
Jia-Yu Du, School of Clinical Medicine, Chengdu Medical College, Chengdu 610000, Sichuan Province, China
Liu Shu, Department of Neuroscience, College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong, China
Yu-Tian Zhou, Department of Geriatrics, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu 610000, Sichuan Province, China
Li Zhang, Department of Geriatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan Province, China
Author contributions: Du JY contributed to conception and design; Zhang L contributed to administrative support; Du JY, Liu S, and Zhou YT contributed to data collection, assembly, analysis and interpretation; all authors contributed to manuscript writing and final approval of the manuscript.
Supported by the Key Research and Development Projects of Sichuan Science and Technology Department, No. 22ZDYF1691, No. 2018FZ0062, and No. 2020YFS0410.
Conflict-of-interest statement: There are no conflicts of interest to report.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Li Zhang, MD, Professor, Department of Geriatrics, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, No. 32 West Section 2, Yihuan Road, Chengdu 610072, Sichuan Province, China. zhangligbyl@med.uestc.edu.cn
Received: July 18, 2022
Peer-review started: July 18, 2022
First decision: August 6, 2022
Revised: August 19, 2022
Accepted: September 19, 2022
Article in press: September 19, 2022
Published online: October 26, 2022
Abstract
BACKGROUND

Liver cirrhosis (LC) is currently the 11th most common cause of death and 15th cause of morbidity globally. The treatment of LC is mainly aimed at etiological intervention, lifestyle intervention, prevention and treatment of complications and nutritional treatment. Nutritional treatment of LC mainly includes increasing dietary intake, food intake time and branched-chain amino acids (BCAAs). Despite the recommendation of BCAAs in some guidelines, adverse effects have been reported in studies so the efficacy and safety of BCAAs remain controversial. Currently, BCAAs have been widely used in chronic liver disease, while the summary of the effect of BCAAs on long-term prognosis is rare.

AIM

To determine the effects of BCAAs in patients with LC.

METHODS

The PubMed, Cochrane Library, Embase and Web of Science databases were searched. The retrieval deadline was 1 October 2021 and there were no language restrictions set in the retrieval. The study was performed in strict accordance with the inclusion and exclusion criteria. Nine studies were finally included. The primary outcome was complications of LC. The secondary outcomes were nutritional status and liver function. This meta-analysis used the Review Manager, version 5 statistical package (Cochrane Collaboration, Oxford, England) for analysis.

RESULTS

The analysis included nine studies that consisted of 1080 patients (554 in the BCAA groups and 526 in the control groups). The nine studies were randomized control trials (RCTs). The quality of the studies was assessed using the risk of bias method recommended by the Cochrane Collaboration. BCAAs reduced the rate of complications in LC patients [Risk ratio: 0.70, 95% confidence interval (CI): 0.56-0.88, P = 0.002] and improved patients’ albumin levels [std mean difference SMD: 0.26, 95%CI: 0.12-0.40, P = 0.0002]. Meanwhile, BCAAs significantly ameliorated the levels of alanine transaminase (SMD: -2.03, 95%CI: -2.52 to -1.53, P < 0.00001) and aspartate aminotransferase (SMD: -1.8, 95%CI: -2.14 to -1.46, P < 0.00001). Meanwhile, glucose in the LC was significantly increased in BCAA-treated patients (MD: 13.04, 95%CI: 6.81-19.89, P = 0.0002).

CONCLUSION

BCAAs reduce the incidence of complications in patients with LC and ameliorate nutritional status.

Keywords: Liver cirrhosis, Branched-chain amino acids, Complications, Nutrition, Liver function, Glucose

Core Tip: Liver cirrhosis (LC) is currently the 11th most common cause of death and the 15th cause of morbidity globally. Nutritional treatment of LC mainly includes increasing dietary intake, food intake time and branched chain amino acids (BCAAs). The efficacy and safety of BCAAs remain controversial. We performed a meta-analysis and nine studies were finally included. The primary outcome was complications of LC. The secondary outcomes were nutritional status and liver function. The conclusion is that branched-chain amino acids reduce the incidence of complications in patients with liver cirrhosis and ameliorate nutritional status.