Comparison of Dietary Protein with an Oral, Branched Chain‐Enriched Amino Acid Supplement in Chronic Portal‐Systemic Encephalopathy: A Randomized Controlled Trial

A randomized study was conducted in 37 hospitalized patients at six cooperating hospitals in which protein‐intolerant cirrhotic patients were fed increasing amounts of either dietary protein or a branched‐chain enriched amino acid solution (BCAA) until they attained an intake of 80 gm protein per day or equivalent or until they developed stage 2 encephalopathy. All patients initially received 20 gm of dietary protein for 1 week, after which 20 gm of protein or BCAA were added weekly. Nitrogen balance improved from negative to positive in all patients in whom it was measured and increased equally in both groups. Seven of the 20 patients in the protein group and 1 of 17 in the BCAA group developed encephalopathy of stage 2 or greater (p < 0.05). Changes in each component of the portal‐systemic encephalopathy syndrome were compared, and differences were statistically significant for mental status grade (p < 0.01), asterixis (p < 0.05), Portal‐systemic encephalopathy index (p < 0.01), but insignificant for Number Connection Test, EEG or ammonia. Plasma amino acid profiles showed an increase in BCAA in the study group. Thus, oral BCAA supplements appear to induce positive nitrogen balance to approximately the same degree as an equivalent amount of dietary protein without inducing encephalopathy as frequently.