Abstract
Cirrhosis patients often have abnormal glucose metabolism. We investigated the effects of a late-evening snack (LES) with branched-chain amino acid-enriched nutrients (BCAA-EN) on glucose metabolism in cirrhosis patients. LES with BCAA-EN was administered for 1 week in 13 patients with cirrhosis and hypoalbuminemia. Blood glucose (BG) levels were measured every 15 min. The patients were divided into two groups based on BG levels: group 1 (G1, n = 11): nocturnal BG levels <200 mg/dL and group 2 (G2, n = 2): nocturnal BG levels ≥200 mg/dL. G1 had nocturnal BG levels <200 mg/dL, whereas G2 had nocturnal BG levels ≥200 mg/dL. The average BG levels did not significantly change after BCAA-EN administration in G1 (before 91.9 ± 29.0 mg/dL; after 89.0 ± 24.3 mg/dl). However, the average BG levels significantly increased after BCAA-EN administration in G2 (before 153.6 ± 43.3 mg/dL; after 200.9 ± 59.7 mg/dL) (p < 0.01). The glycated albumin level (16.6 ± 0.9% vs. 16.2 ± 2.1%), fasting immunoreactive insulin (F-IRI) level (53.9 ± 34.0 μU/mL vs. 16.5 ± 11.0 μU/mL), and homeostasis model assessment of insulin resistance (HOMA-IR) score (17.85 ± 10.58 vs. 4.02 ± 2.59) were significantly higher in G2 than in G1 (p < 0.05, p < 0.05, and p < 0.01, respectively). The quantitative insulin sensitivity check indices (0.32 ± 0.03 vs. 0.27 ± 0.02) were significantly higher in G1 than in G2 (p < 0.01). One patient in G2 was obese and had type 2 diabetes. The other patient was obese and had a high HOMA-IR score and F-IRI level. A LES with BCAA-EN does not inhibit overt diabetes in most cirrhosis patients. However, close attention should be paid to fluctuations in BG levels in cirrhosis patients who present with obesity and severe insulin resistance.
Highlights
The liver is an essential organ in regulating the biological processes of glucose, protein, and energy metabolism
Two different Branched-chain amino acids (BCAAs) formulations (BCAA granules [BCAA-GR: LIVACT granules, Eisai Co., Ltd., Tokyo, Japan], which contain 4 g of BCAA and 16 kcal of energy per pack [4,5], and BCAA-enriched nutrients [branched-chain amino acid-enriched nutrients (BCAA-EN): Aminoleban EN, Otsuka Pharmaceutical, Tokyo, Japan], which contain 5.6 g of BCAA and 210 kcal of energy per pack) were approved for the treatment of patients with cirrhosis who present with hypoalbuminemia
Late-evening snacks (LES) with BCAA has been recommended as a nutritional treatment for patients with cirrhosis who present with hypoalbuminemia [15]
Summary
The liver is an essential organ in regulating the biological processes of glucose, protein, and energy metabolism. Patients with cirrhosis have lower serum BCAA levels [2,3]. BCAA supplementation prevents various complications, including hepatic encephalopathy, and improves event-free survival and quality of life in patients with cirrhosis [2]. Results of randomized controlled trials have revealed that nocturnal administration of BCAA-EN improves liver function and nutritional status in patients with cirrhosis [7]. LES is recommended for patients with cirrhosis to prevent starvation status in the morning according to the European Society for Clinical Nutrition and Metabolism [8] and the American Society for Parenteral and Enteral Nutrition guidelines [9]. The effect of BCAA-EN administration on glucose metabolism in patients with cirrhosis has not been fully elucidated. This study aimed to investigate the effects of LES with BCAA-EN on glucose metabolism in patients with cirrhosis
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