Abstract
The long-term outcomes of branched-chain amino acid (BCAA) administration in patients undergoing hepatic resection remain unclear. The aim of this study is to assess the impact of oral supplementation with BCAA-enriched nutrients on postoperative quality of life (QOL) in patients undergoing liver resection. A prospective randomized clinical trial was conducted in 96 patients undergoing hepatic resection. Patients were randomly assigned to receive BCAA supplementation (AEN group, n = 48) or a conventional diet (control group, n = 48). Postoperative QOL and short-term outcomes were regularly and continuously evaluated in all patients using a short-form 36 (SF-36) health questionnaire and by measuring various clinical parameters. This study demonstrated a significant improvement in QOL after hepatectomy for liver neoplasm in the AEN group based on the same patients’ preoperative SF-36 scores (P < 0.05). Perioperative BCAA supplementation preserved liver function and general patient health in the short term for AEN group patients compared to those not receiving the nutritional supplement. BCAA supplementation improved postoperative QOL after hepatic resection over the long term by restoring and maintaining nutritional status and whole-body kinetics. This study was registered at http://www.clinicaltrials.gov (registration number: NCT00945568).
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Alberino F, Gatta A, Amodio P, Merkel C, Di Pascoli L, Boffo G et al (2001) Nutrition and survival in patients with liver cirrhosis. Nutrition 17:445–450
Banz VM, Inderbitzin D, Fankhauser R, Studer P, Candinas D (2009) Long-term quality of life after hepatic resection: health is not simply the absence of disease. World J Surg 33:1473–1480
Bianchi G, Marzocchi R, Agostini F, Marchesini G (2005) Update on branched-chain amino acid supplementation in liver diseases. Curr Opin Gastroenterol 21:197–200
Blei AT, Cordoba J (2001) Hepatic encephalopathy. Am J Gastroenterol 96:1968–1976
Caregaro L, Alberino F, Amodio P, Merkel C, Bolognesi M, Angeli P et al (1996) Malnutrition in alcoholic and virus-related cirrhosis. Am J Clin Nutr 63:602–609
Giovannini I, Chiarla C, Giuliante F, Vellone M, Ardito F, Nuzzo G (2006) The relationship between albumin, other plasma proteins and variables, and age in the acute phase response after liver resection in man. Amino Acids 31:463–469
Ikegami N, Drummond M, Fukuhara S, Nishimura S, Torrance GW, Scubert F (2002) Why has the use of health economic evaluation in Japan lagged behind that in other development countries? Pharmacoeconomics 20:1–7
Kogo M, Kano A, Kiuchi Y, Mitamura K, Yoneyama K (2007) Prognostic index for survival in patients after treatment for primary hepatocellular carcinoma. Dig Dis Sci 52:2444–2451
Lautz HU, Selberg O, Korber J, Burger M, Muller MJ (1992) Protein-calorie malnutrition in liver cirrhosis. Clin Invest 70:478–486
Lee LJ, Chen CH, Yao G, Chung CW, Sheu JC, Lee PH et al (2007) Quality of life in patients with hepatocellular carcinoma received surgical resection. J Surg Oncol 95:34–39
Marchesini G, Bianchi G, Merli M, Amodio P, Panella C, Loguercio C et al (2003) Italian BCAA Study Group. Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial. Gastroenterology 124:1792–1801
Marchesini G, Marzocchi R, Noia M, Bianchi G (2005) Branched-chain amino acid supplementation in patients with liver diseases. J Nutr 135:1596S–1601S
Meng WC, Leung KL, Ho RL, Leung TW, Lau WY (1999) Prospective randomized control study on the effect of branched-chain amino acids in patients with liver resection for hepatocellular carcinoma. Aust NZ J Surg 69:811–815
Miwa Y, Moriwaki H (2004) Nocturnal energy and BCAA supplementation in patients with liver cirrhosis. Hepatol Res 30S:63–66
Moriwaki H, Miwa Y, Tajika M, Kato M, Fukushima H, Shiraki M (2004) Branched-chain amino acids as a protein- and energy-source in liver cirrhosis. Biochem Biophys Res Commun 313:405–409
Ogata S, Belghiti J, Varma D, Sommacale D, Maeda A, Dondero F et al (2007) Two hundred liver hanging maneuvers for major hepatectomy: a single-center experience. Ann Surg 245:31–35
Okabayashi T, Nishimori I, Sugimoto T, Maeda H, Dabanaka K, Onishi S et al (2008a) Effects of branched-chain amino acids-enriched nutrient support for patients undergoing liver resection for hepatocellular carcinoma. J Gastroenterol Hepatol 23:1869–1873
Okabayashi T, Nishimori I, Sugimoto T, Iwasaki S, Akisawa N, Maeda H et al (2008b) The benefit of the supplementation of perioperative branched-chain amino acids in patients with surgical management for hepatocellular carcinoma: a preliminary study. Dig Dis Sci 53:204–209
Okabayashi T, Nishimori I, Yamashita K, Sugimoto T, Namikawa T, Maeda H et al (2010) Preoperative oral supplementation with carbohydrate and branched-chain amino acid-enriched nutrient improves insulin resistance in patients undergoing a hepatectomy: a randomized clinical trial using an artificial pancreas. Amino Acids 38:901–907
Pacella CM, Francica G, Di Lascio FM, Arienti V, Antico E, Caspani B et al (2009) Long-term outcome of cirrhotic patients with early hepatocellular carcinoma treated with ultrasound-guided percutaneous laser ablation: a retrospective analysis. J Clin Oncol 27:2615–2621
Poon RT, Fan ST, Yu WC, Lam BK, Chan FY, Wong J (2001) A prospective longitudinal study of quality of life after resection of hepatocellular carcinoma. Arch Surg 136:693–699
Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK et al (2004) Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 240:698–708
Richter S, Kollmar O, Schuld J, Moussavian MR, Igna D, Schilling MK (2009) Chirurgische Arbeitsgemeinschaft OP-Technik und OP-Strukturen (CAOP) of the Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie. Randomized clinical trial of efficacy and costs of three dissection devices in liver resection. Br J Surg 96:593–601
Sajid MS, Iftikhar M, Rimple J, Baig MK (2008) Use of health-related quality of life tools in hepatobiliary surgery. Hepatobiliary Pancreat Dis Int 7:135–137
Tajika M, Kato M, Mohri H, Miwa Y, Kato T, Ohnishi H et al (2002) Prognostic value of energy metabolism in patients with viral liver cirrhosis. Nutrition 18:229–234
The San-in Group of Liver Surgery (1997) Long-term oral administration of branched chain amino acids after curative resection of hepatocellular carcinoma: a prospective randomized trial. Br J Surg 84:1525–1531
Tomiya T, Omata M, Fujiwara K (2004) Significance of branched chain amino acids as possible stimulators of hepatocyte growth factor. Biochem Biophys Res Commun 313:411–416
Acknowledgments
This study was supported by the Ministry of Education, Culture, Sports, Science, and Technology, The Uehara Memorial Foundation, and the Kochi University Discretionary Fund.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Okabayashi, T., Iyoki, M., Sugimoto, T. et al. Oral supplementation with carbohydrate- and branched-chain amino acid-enriched nutrients improves postoperative quality of life in patients undergoing hepatic resection. Amino Acids 40, 1213–1220 (2011). https://doi.org/10.1007/s00726-010-0748-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00726-010-0748-3