In a double blind randomized study,
branched-chain amino acids and placebo (
casein) were compared as a treatment for chronic
hepatic encephalopathy in
cirrhosis. After a 15-day run-in period with controlled diet (45-65
g protein), the patients were administered, in addition to their diet,
branched-chain amino acids (0.24 g/kg, 30 patients) or an equinitrogenous amount of
casein (34 patients). One patient on
branched-chain amino acids and two on
casein were lost to the study. After 3 months, the index of
portal-systemic encephalopathy significantly improved in patients on active treatment (from 40 [S.D. 14]% to 21 [17]), but was not in subjects receiving
casein (from 37 [13]% to 36 [12]). Two or more parameters of the index improved in 24 patients treated with
amino acids (80%; confidence limits, 61-92%), and only in 12 receiving
casein (35%; confidence limits, 20-54%; p less than 0.001). Patients who did not improve were given an alternative treatment for 3 more months.
Casein-treated patients given
branched-chain amino acids rapidly improved. The changes in neuropsychologic function were associated with an improvement in semiquantitative
nitrogen balance, which became consistently positive in
amino acid-treated subjects; there was also a mild improvement in nutritional parameters and in liver function tests. The supplementation of oral
branched-chain amino acids to the diet is superior to
casein as a treatment for providing adequate
nitrogen supply and improving the mental state of cirrhotic patients with
chronic encephalopathy.