Effect of branched-chain amino acid supplementation and exercise on quadriceps muscle quantity and quality in patients with cirrhosis as assessed by ultrasonography: A randomized controlled trial

Abstract

Background/aimSarcopenia and myosteatosis are common in patients with cirrhosis. The study aimed to evaluate efficacy of ultrasound to monitor muscle status during branched-chain amino acid (BCAA) supplementation and/or muscle exercise interventional approaches. Patients & MethodsA randomized controlled study, included 220 liver cirrhosis patients with Child- Pugh B & C, randomized into a control group (55 patients) received only the standard care, and interventional groups (165 patients) equally distributed into three subgroups, in addition to standard care, they received BCAA, programmed exercise, or BCAA and programmed exercise. At baseline and after 28 days, all participants were subjected to ultrasound-measured quadriceps muscle thickness and echo-intensity, muscle strength using handgrip, performance using short physical performance battery (SPPB), MELD score and nutritional assessment using 7- subjective global assessment score (SGA) and laboratory assessment. ResultsAll interventional groups showed a significant improvement in the ultrasound detected quadriceps muscle thickness (p = 0.001) & echo intensity, in addition to muscle strength, muscle performance, and SGA. Hematological parameters (hemoglobin & platelet count), biochemical parameters (ALT, AST, bilirubin, creatinine, urea and INR) & MELD score were also improved in the interventional groups. In Child-Pugh B patients BCAA combined with exercise showed an add-on effect. ConclusionBCAA supplements, programed muscle exercise and both are useful interventional methods in improving muscle quality and quantity in cirrhosis patients, which can be monitored by ultrasound. The best results can be achieved by combined intervention in Child-Pugh B, while in Child-Pugh C single intervention may lead to an acceptable improvement. The trial was registered retrospectively in the Clinical Trials RegistryRegistration number NCT06088550).