TBA (23W153)

Adding Branched-Chain Amino Acids to a Standard-of-Care Treatment Improves Muscle Mass and frailty of Cirrhotic Patients: A Randomised Controlled Trial

Author(s)

Reza Saeidi 1,2, Neasa Mc Gettigan 1,2, Ciara O’Connor2, John Ryan 1,2, Karen Boland 1,2

Department(s)/Institutions

1. Department of Gastroenterology & Hepatology, Beaumont Hospital, Dublin, Ireland 2. School of Medicine, Royal College of Surgeons in Ireland

Introduction

Sarcopenia (low muscle mass, strength, and function) and frailty are associated with adverse outcomes in cirrhosis, including hepatic encephalopathy, ascites, infection, and increased hospitalisation. The effect of branched-chain amino acid (BCAA) supplementation on muscle mass and frailty in patients with cirrhosis and sarcopenia is unknown.

Aims/Background

Our aim is to the potential of BCAA in enhancing muscle mass and mitigating frailty among individuals with cirrhosis.

Method

Cirrhotic patients were recruited from a single center tertiary hospital for this prospective, randomized controlled trial. Consecutive patients with cirrhosis were randomized to receive either 30g/day BCAA orally (BCAA group) or continue with standard medical therapy (NBCA-group) for 3 months with initial assessment conducted during third week. Nutritional status, muscle and fat mass were assessed using BIA (SECA mBCA 525) as the reference. Sergi-sarcopenia-equation were employed for muscle mass/appendiceal muscle mass index (ASMI) measurements. Validated muscle strength and functional metrics {handgrip strength (HGS), sit-to-stand (STS) and short physical performance battery (SPPB)} and liver-frailty-index (LFI) were recorded. Statistical analysis was performed using Stata version 17.0. P value <0.05 was considered significant.

Results

Total of eighty-eight individuals recruited. 52 patients {mean age 58±10; males (52%) of predominantly alcohol (65%) and MASH (13%) were randomised. 36 healthy controls (HCs) {mean age 51± 11, 41% male} were also included. Compared to HCs, cirrhotic patients had lower muscle strength (HGS 36.6 ± 10 vs 25.3 ± 9, p<0.001; STS 8.9 ± 2.2 vs 14.4 ± 7.1, p<0.001), performance (SPPB 11.80 ± 0.47 vs 9.9 ± 2.41, p<0.001) and nutritional status (PhA 6.51 ± 0.9 vs 4.89 ± 0.97, p<0.001). In cirrhotic patients, supplement compliance was 81% (SD = 16) at week 12 and well-tolerated. Baseline clinical and demographic characters of patients were similar apart from more males (n=17 vs 10 ,p=0.02) and higher BMI (30.4±7 vs 26.4±4.8, p=0.01) in NBCA group and lower ASMI in BCAA group (6.59±1.22 vs 7.69±1.36, p=0.003). In patients receiving BCAA, there was high muscle mass (ASMI) at week 3 (Δ0.37, CI 0.06—0.71 with p=0.02) but not at week 12 (Δ0.14, CI -0.07—0.36, p=0.02). Eight (15%) patients (n=6 BCAA, n=2 NBCA) had sarcopenia at baseline. Overall, on week 12, 49% of patients showed improvement in ASMI, which were more frequent in BCAA group, 83% vs 59% in NBCA with p=0.02. Reduced frailty(LFI) was noted in BCAA group (Δ-0.32, CI -0.57—-0.08, p=0.008) and week 12 (Δ-0.21, CI -0.40—-0.01, p=0.03). Secondary outcomes including handgrip strength (p>0.13), STS (>0.16), SPPB (p>0.19) and serum albumin level (p=0.44) were similar in both arms at both time points.

Conclusions

Addition of BCAA to standard of care in cirrhotic patient leads to improvement in frailty and muscle mass of patient with cirrhosis. It is important to note that the improvements in muscle mass were primarily observed in the short term. Alongside BCAA supplementation, the incorporation of exercise may be necessary to effectively enhance and sustain muscle mass in patients with liver cirrhosis and will be evaluated as part of study evolution.