Update on branched-chain amino acid supplementation in liver diseases

Purpose of review Branched-chain amino acids (BAAs) have a peculiar role in whole-body nitrogen metabolism, BCAAs are a substrate for protein synthesis, and have been used to conserve or restore muscle mass in advanced liver disease. In addition the competitive action of BCAAs on amino acid transport across the blood-brain barrier may improve hepatic encephalopathy. Recent findings The effects of branched-chain amino acids on nutrition and ultimately on prognosis of patients with advanced cirrhosis have been confirmed in a large multicenter, long-term trial. Similarly, BCAA treatment improved the prognosis of patients with hepatocellular carcinoma, treated by chemoembolization. the mechanism for the beneficial effects of BCAA is likely to depend on the stimulating activity of BCAA on hepatocyte growth factor, favoring liver regeneration. Summary After an experience of 25 years with branched-chain amino acids, new data supports their beneficial effect in liver diseases. Although the number of patients who cannot tolerate dietary proteins in amounts sufficient to meet their increased catabolism is probably low in this specific setting BCAAs remain the sole treatment of proved efficacy.