Original Contribution | Published:


Effects of Branched-Chain Amino Acids Supplementation in Patients With Cirrhosis and a Previous Episode of Hepatic Encephalopathy: A Randomized Study

The American Journal of Gastroenterology volume 106, pages 10811088 (2011) | Download Citation



Protein intake impacts on nutritional status and may determine the recurrence of hepatic encephalopathy (HE). A low-protein diet has been considered the standard treatment after an episode of HE, while branched-chain amino acids (BCAA) have been shown to improve minimal HE. We performed a study to investigate the long-term effects of supplementing a protein-controlled diet with BCAA.


A randomized, double-blind, multicenter study that included 116 patients with cirrhosis and a previous episode of HE was conducted in four tertiary care hospitals. All patients received a standard diet of 35 kcal/kg per day and 0.7 g of proteins/kg per day and a supplement of 30 g of BCAA (BCAA group) or maltodextrin (MDX group) during 56 weeks.


The actuarial risk of remaining free of HE did not differ between groups (BCAA=47%, MDX=34%, P=0.274), but patients in the BCAA group exhibited a better outcome on two neuropsychological tests and an increase in the mid-arm muscle circumference. Recurrence was associated with low plasma albumin at baseline and a decrease in sodium and an increase in creatinine during follow-up. Patients with recurrence of HE exhibited a lack of improvement in global cognitive function.


Diet supplementation with BCAA after an episode of HE does not decrease recurrence of HE. However, supplementation with BCAA improves minimal HE and muscle mass. Identification of risk factors for recurrence of HE may allow the development of new preventive therapies that could decrease the neuropsychological sequelae of repeated episodes of HE.

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  1. Servei de Medicina Interna-Hepatologia, Hospital Vall d’Hebron, Barcelona, Spain

    • Iñigo Les
    • , Rita García-Martínez
    • , Montse Flavià
    • , Beatriz Mínguez
    • , Rafael Esteban
    •  & Juan Córdoba
  2. Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain

    • Iñigo Les
    • , Rita García-Martínez
    • , Rafael Esteban
    •  & Juan Córdoba
  3. Departament de Psicobiologia i de Metodologia de les Ciències de la Salut, Universitat Autònoma de Barcelona, Barcelona, Spain

    • Eduardo Doval
  4. Unitat de Suport Nutricional, Hospital Vall d’Hebron, Barcelona, Spain

    • Mercè Planas
    • , Guillermo Cárdenas
    •  & Pilar Gómez
  5. Unitat de Neuropsicologia, Hospital Vall d’Hebron, Barcelona, Spain

    • Carlos Jacas
  6. Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain

    • Carlos Jacas
    • , Beatriz Mínguez
    • , Mercedes Vergara
    • , Germán Soriano
    • , Rafael Esteban
    •  & Juan Córdoba
  7. Servei de Aparell Digestiu, Corporació Sanitaria Parc Taulí, Sabadell, Spain

    • Mercedes Vergara
  8. Servei de Aparell Digestiu, Hospital Sant Pau, Barcelona, Spain

    • Germán Soriano
  9. Servei de Aparell Digestiu, Hospital del Mar, Barcelona, Spain

    • Carmen Vila


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Competing interests

Guarantor of the article: Juan Córdoba, MD.

Specific author contributions: Selection and treatment of patients, acquisition of data, analysis and interpretation of data, and drafting of manuscript: Iñigo Les; statistical analysis and critical review of manuscript: Eduardo Doval; treatment of patients, analysis and interpretation of data, and critical review of manuscript: Rita García-Martínez; nutritional management of patients and monitoring of data: Mercè Planas, Guillermo Cárdenas, and Pilar Gómez; performance and analysis of neuropsychological tests: Montse Flavià, and Carlos Jacas; selection and treatment of patients and acquisition of data: Beatriz Mínguez, Mercedes Vergara, Germán Soriano, and Carmen Vila; organization of the study and critical review of manuscript: Rafael Esteban; obtained funding, study concept and design, selection and treatment of patients, analysis and interpretation of data, drafting of manuscript, supervision of the study: Juan Cordoba.

Financial support: This project has been supported by the grant FIS 03/072. CIBERehd is supported by Instituto de Salud Carlos III, Madrid, Spain. R.G.-M. is the recipient of the grant FIS CM07/00109. The nutritional supplements were kindly provided by SHS International. The authors conducted the design and analysis of the study without receiving any specific financial support.

Potential competing interests: None.

Corresponding author

Correspondence to Juan Córdoba.

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