Nutritional treatment with branched-chain amino acids in advanced liver cirrhosis.
Nutritional treatment with branched-chain amino acids in advanced liver cirrhosis.
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支链氨基酸对晚期肝硬化的营养治疗。
DOI：
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发表时间：
2000
影响因子：
6.3
通讯作者：
N. Melchionda
中科院分区：
文献类型：
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作者：
G. Marchesini;G. Bianchi;B. Rossi;M. Brizi;N. Melchionda
在过去的20年里，对晚期肝硬化患者的营养治疗引起了很大的兴趣。大多数研究已经测量了膳食蛋白、通用蛋白水解物或特定支链氨基酸（BCAA）富集配方的营养补充剂在营养参数和肝性脑病方面的潜在益处。这个问题还没有最终解决;数据相互矛盾，荟萃分析未能产生明确的结果。最近在欧洲肠外和肠内营养学会的主持下进行的一项共识综述得出结论：（1）肝硬化患者倾向于高代谢，需要高于正常水平的膳食蛋白质供应来实现氮平衡;（2）大多数患者耐受正常或甚至增加的膳食蛋白质摄入，而没有肝性脑病的风险;（3）基于多餐和深夜零食的改良的饮食模式是有用的;（4）在严重营养不良的患者中，可以考虑氨基酸补充剂以提供必要量的蛋白质以满足蛋白质需求;（5）在少数不能耐受所需蛋白质摄入的患者中，BCAA补充剂可以被认为提供必要的氮摄入量，而不会对精神状态产生有害影响，未来的研究需要量化氨基酸或BCAA补充剂的营养支持对整体健康，并发症和长期疾病的最终生存率的优势，其中自我感知的健康相关生活质量是主要结果。
During the last 20 years there has been much interest in nutritional treatment for patients with advanced cirrhosis. Most studies have measured the potential benefit of nutritional supplements of dietary proteins, generic protein hydrolysates, or specific branched-chain amino acid (BCAA)-enriched formulas in regard to nutritional parameters and hepatic encephalopathy. The issue is not definitively settled; data are conflicting and meta-analyses have failed to produce unequivocal results. A consensus review, recently produced under the auspices of the European Society for Parenteral and Enteral Nutrition, concluded that: (1) patients with cirrhosis tend to be hypermetabolic, and a higher-than-normal supply of dietary proteins is needed to achieve nitrogen balance; (2) most patients tolerate a normal or even increased dietary protein intake, without risk of hepatic encephalopathy; (3) a modified eating pattern, based on several meals and a late evening snack, is useful; (4) in severely malnourished patients, amino acid supplements may be considered to provide the necessary amount of proteins to meet protein requirements; (5) in a few patients intolerant to the required protein intake, BCAA supplements may be considered to provide the necessary nitrogen intake without detrimental effects on the mental state, perhaps even improving it. Future studies are needed to quantify the advantage of nutritional support with amino acids or BCAA supplements on overall well-being, complications, and ultimately survival with a long-lasting disease where self-perceived health-related quality of life is a major outcome.