The Impact of Branched Chain Amino Acids (BCAA) Supplementation in Patients with Advanced Liver Disease

Advanced liver disease, or cirrhosis, is associated with increased morbidity and mortality and patients suffer frequent complications. Sarcopenia, defined as the the loss of muscle mass as well as muscle function, is among the commonest complications, with an estimated prevalence of up to 70%. Sarcopenia is independently associated with reduced survival, increased infection risk and higher rates of hospitalisation in this cohort. Despite this, little is known about how to increase muscle mass in this population. Branched chain amino acids (BCAAs) include three essential amino acids which are used as building blocks for protein and energy in muscle. In addition to being the primary energy source for skeletal muscle, they are also used to help clear toxins that build up in liver disease. Patients with cirrhosis have reduced levels of BCAAs, which is thought to be a major contributing factor that contributes to low muscle mass in these patients. Treating patients with oral BCAA supplements, in the form of a soluble powder, may improve quality of life and overall nutrition in patients with cirrhosis. However, the impact on muscle mass is unknown. Our study aims to investigate the effect of oral BCAA powdered supplements on sarcopenia in patients with cirrhosis. Our randomised trial will compare BCAAs to a control protein supplement to assess whether replacing dietary protein deficit as a whole or BCAAs specifically can influence outcomes. Our primary outcome will be an increase in muscle mass and strength in treated subjects. If we can improve sarcopenia, we anticipate we may also improve other outcomes. Therefore, our secondary outcomes of this study will be improved muscle function, hepatic encephalopathy, insulin resistance, rates of hospitalisation, health care costs, quality of life and overall mortality. Given the higher rates of infections seen in patients with sarcopenia, the second focus of our study will be on immune function through monitoring blood samples and infectious complications.