Clinical Assessment of Nutritional Status in Patients with Liver Cirrhosis with Special Reference to Plasma Amino Acid Imbalance

Abstract

Nutritional status in patients with liver cirrhosis was evaluated with the use of anthropometric, visceral protein, and immunological parameters, with special reference to plasma amino acid imbalance. By cluster analysis using 7 nutritional parameters, we identified 10 groups (clusters). Most of the patients with decompensated liver cirrhosis (82.3%) were distributed into Clusters VIII, IX, and X, exhibiting a marked decrease in visceral protein status with or without reduced anthropometric parameters (i.e., kwashiorkor-like syndrome). In addition, the reduction in visceral protein status (serum albumin, transferrin, prealbumin, and retinol-binding protein) was highly correlated with plasma amino acid imbalance, i.e., the decrease in the molar ratio of branched-chain amino acids (BCAA) to aromatic amino acids (Fischer's ratio). Moreover, the plasma clearance rate of BCAA, but not that of other essential and nonessential amino acids, was found to be significantly increased in cirrhotic patients, suggesting that the decrease in plasma BCAA is due mainly to augmented utilization of these amino acids by the peripheral tissues (i.e., skeletal muscle, etc.). These findings support the view that nutritional therapy with BCAA supplementation is of practical importance for clinical improvement of the protein malnutrition often observed in patients with liver cirrhosis.