Amino Acid Profile in Malnourished Patients with Liver Cirrhosis and Its Modification with Oral Nutritional Supplements: Implications on Minimal Hepatic Encephalopathy

Low plasma levels of branched chain amino acids (BCAA) in liver cirrhosis are associated with hepatic encephalopathy (HE). We aimed to identify a metabolic signature of minimal hepatic encephalopathy (MHE) in malnourished cirrhotic patients and evaluate its modification with oral nutritional supplements (ONS) enriched with ß-Hydroxy-ß-methylbutyrate (HMB), a derivative of the BCAA leucine. Post hoc analysis was conducted on a double-blind placebo-controlled trial of 43 individuals with cirrhosis and malnutrition, who were randomized to receive, for 12 weeks, oral supplementation twice a day with either 220 mL of Ensure® Plus Advance (HMB group, n = 22) or with 220 mL of Ensure® Plus High Protein (HP group, n = 21). MHE evaluation was by psychometric hepatic encephalopathy score (PHES). Compared to the HP group, an HMB-specific treatment effect led to a larger increase in Val, Leu, Phe, Trp and BCAA fasting plasma levels. Both treatments increased Fischer’s ratio and urea without an increase in Gln or ammonia fasting plasma levels. MHE was associated with a reduced total plasma amino acid concentration, a reduced BCAA and Fischer´s ratio, and an increased Gln/Glu ratio. HMB-enriched ONS increased Fischer´s ratio without varying Gln or ammonia plasma levels in liver cirrhosis and malnutrition, a protective amino acid profile that can help prevent MHE.

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Sarcopenia predicts minimal hepatic encephalopathy in patients with liver cirrhosis

Hepatology Research ◽

10.1111/hepr.12873 ◽

2017 ◽

Vol 47 (13) ◽

pp. 1359-1367 ◽

Cited By ~ 38

Author(s):

Tatsunori Hanai ◽

Makoto Shiraki ◽

Satoshi Watanabe ◽

Takahiro Kochi ◽

Kenji Imai ◽

...

Keyword(s):

Liver Cirrhosis ◽

Hepatic Encephalopathy ◽

Minimal Hepatic Encephalopathy

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The Role of L-ornithine-L-aspartate in the Management of Minimal Hepatic Encephalopathy among Patients with Liver cirrhosis: a Systemic review and Meta-analysis

Acta Medica Philippina ◽

10.47895/amp.v52i1.487 ◽

2018 ◽

Vol 52 (1) ◽

Author(s):

Henry Winston C. Li ◽

Maria Ana Louise M. Naidas ◽

Karen Anjela M. Mondragon ◽

Ruter M. Maralit

Keyword(s):

Liver Cirrhosis ◽

Hepatic Encephalopathy ◽

Meta Analysis ◽

Block Design ◽

Cochrane Collaboration ◽

Minimal Hepatic Encephalopathy ◽

Systemic Review ◽

Cochrane Library ◽

P Value ◽

Picture Completion

Objective. To evaluate the efficacy of L-ornithine-L-aspartate (LOLA) in improving minimal hepatic encephalopathy in adult patients with liver cirrhosis. Methods. A search in PubMed, Cochrane Library, Google Scholar, and Medline was made obtaining four qualified randomized controlled trials. Studies included adult cirrhotic patients with minimal hepatic encephalopathy measured by the number connection test (NCT-A, B), figure connection test (FCT-A, B), picture completion, block design test, and critical flicker frequency (CFF) testing with a cut-off score of <39Hz. Methodologic assessment of studies was performed using Cochrane Collaboration Risk of Bias Tool and Review Manager (RevMan) version 5.3 for statistical analysis. Results. Of the 29 studies identified, 4 fulfilled the inclusion criteria, which entailed analysis of 238 participants (LOLA: 116, Control: 122). Three out of the four studies were used in meta-analysis and one study was analyzed separately due to a difference in the neuropsychometric measure. The metaanalysis favored experimental group (LOLA), with a mean difference of 2.29 (95% CI 0.72 – 3.86), p-value = 0.004, and an I2 of 18%. Conclusion. LOLA provided great potential in managing encephalopathy since treating earlier related to better survival and prevention of disease progression. The results of our study supported such evidence and its use may be encouraged.

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M1718 Minimal Hepatic Encephalopathy Does Not Impair Quality of Life in Patients with Liver Cirrhosis: A Single Centre, Prospective Study

Gastroenterology ◽

10.1016/s0016-5085(09)61918-1 ◽

2009 ◽

Vol 136 (5) ◽

pp. A-417 ◽

Cited By ~ 2

Author(s):

Ewa Wunsch ◽

Barbara Szymanik ◽

Michal Post ◽

Wojciech M. Marlicz ◽

Piotr Milkiewicz

Keyword(s):

Quality Of Life ◽

Liver Cirrhosis ◽

Hepatic Encephalopathy ◽

Prospective Study ◽

Minimal Hepatic Encephalopathy ◽

Single Centre

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3-Nitro-Tyrosine as a Biomarker of Minimal Hepatic Encephalopathy in Patients with Liver Cirrhosis

QJM ◽

10.1093/qjmed/hcaa052.027 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

E A Awad ◽

M N Mohammed ◽

M M Sayyed ◽

A E Elkhayal ◽

M A S Ahmed

Keyword(s):

Liver Cirrhosis ◽

Hepatic Encephalopathy ◽

Motor Coordination ◽

Serum Levels ◽

Minimal Hepatic Encephalopathy ◽

Neurological Status ◽

Trail Making Test ◽

University Hospitals ◽

Predictive Values ◽

Trail Making

Abstract Background hepatic encephalopathy (HE) is a common complication in patient with liver cirrhosis. It comprises of a broad spectrum of neuropsychiatric abnormalities of varying severity, and affected patients usually suffer from psychomotor, cognitive, emotional, behavioural, and motor coordination dysfunctions. Patients with minimal HE (MHE), a subclinical form of HE, usually have a normal mental and neurological status upon routine clinical examination. The subtle deficits in patients with MHE can only be elicited by specialized neuropsychological tests. Aim of the Work the aim of this study was to evaluate the role of 3-Nitro-Tyrosine as a biomarker of Minimal Hepatic Encephalopathy in patients with liver cirrhosis. Patients and Methods our conducted study was a prospective case control study carried on 60 adult patients and 30 age matched controls. All were recruited from Internal Medicine and Hepatology and Gastroenterology Department at Ain Shams University Hospitals in the period between September 2016 and June 2018. All patients enrolled in the study were subjected to detailed history taking, full physical examination, laboratory investigations, psychometric tests for detection of MHE using specially digit symbol test (DST), Trail making test A (TMT A), Trail making test B (TMT B), serial dotting test (SDT) and 3-Nitro-Tyrosine level (3NT). Results our study found that the serum levels of 3-nitro-tyrosine are a good predictor of the presence of MHE in patients with liver cirrhosis, with good sensitivity (90%) and specificity (93.33%) and positive and negative predictive values were 93.1% and 90.3% respectively at a cutoff of 14.8 ng. Conclusion determination of 3-nitro-tyrosine in serum is easy and is not time consuming. It only requires taking a serum sample from the patient and determining 3-nitro-tyrosine concentration. This procedure can be therefore easily added to the routine clinical determinations in patients with liver cirrhosis. This would also allow extending the diagnosis of MHE to most clinical settings, helping to identify patients with MHE.

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