Synopsis

Source of validity: Scientific
Rating (out of 5): 3

Branched-chain amino acids (BCAAs)—leucine, isoleucine, and valine—are used in the management of liver cirrhosis, especially to address complications such as hepatic encephalopathy (HE) and protein-energy malnutrition. Cirrhotic patients often have altered amino acid metabolism, resulting in decreased BCAA levels and increased aromatic amino acids, which is associated with impaired cognitive function and muscle wasting. Several randomized controlled trials and meta-analyses have evaluated BCAA supplementation in cirrhosis. Findings suggest that oral BCAA supplementation can improve HE symptoms and quality of life, although effects on overall mortality are less clear. A 2014 Cochrane review concluded that BCAAs have a beneficial effect on hepatic encephalopathy, improving manifestations of HE compared to placebo or standard therapy, but there was no significant reduction in mortality. Additionally, clinical guidelines (such as those from the European Society for Clinical Nutrition and Metabolism, ESPEN) recommend BCAA supplementation in specific cases, particularly for patients with recurrent or persistent HE and in those unable to meet their nutritional requirements. The evidence base is moderate, with some heterogeneity in study results and populations. Overall, the use of BCAAs in cirrhosis is scientifically validated for specific indications, especially for symptomatic management of HE and nutritional support, but it is not a universal therapy for all cirrhotic patients.

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