P4648 - Branched-Chain Amino Acids Supplementations for Sarcopenic Patients with Liver Cirrhosis: A Systematic Review and Meta-Analysis

Ahmed Fares, MD¹, Mohamed Abuelazm, MD², Mahmoud M.. Elhady, MBBCh³, Ahmed Mazen Amin, MBBCh⁴, Ubaid Khan, MD⁵, Ibrahim Gowaily, MBBCh², Fouad Jaber, MD, MS^6
1Tufts Medical Center, Boston, MA; ²Tanta University, Tanta, Al Gharbiyah, Egypt; ³Benha University, Benha, Al Qalyubiyah, Egypt; ⁴Mansoura University, Mansoura, Ad Daqahliyah, Egypt; ⁵University of Maryland, Baltimore, MD; ⁶University of Missouri - Kansas City School of Medicine, Kansas City, MO

Introduction: Sarcopenia, characterized by reduced muscle mass and function, is prevalent in 30–70% of Liver Cirrhosis (LC) patients and predicts poor survival. Branched-chain amino acids (BCAAs) supplementation has shown potential in managing sarcopenia by improving nutritional status and liver function. However, results across studies are inconsistent. This systematic review and meta-analysis evaluates the efficacy and safety of BCAAs in sarcopenia management in LC patients.

Methods: A systematic review and meta-analysis synthesizing evidence from randomized control trials (RCTs) obtained from PubMed, Embase, Cochrane, Scopus, and Web of Science from inception to April 2024. We used the fixed-effects model to report dichotomous outcomes using risk ratio (RR) and continuous outcomes using mean difference (MD), with a 95% confidence interval (CI). PROSPERO ID: CRD42024542761.

Results: Five RCTs with 434 patients were included. BCAAs were significantly associated with decreased liver frailty index change (MD: -0.14 with 95% CI [-0.28, -0.01], P= 0.03; figure 1A). However, there was no significant difference between BCAAs and the control group regarding hand grip strength change (MD: 0.98 with 95% CI [-0.45, 2.41], P= 0.18; figure 1B). Also, BCAAs were significantly associated with increased BMI change (MD: 0.99 with 95% CI [0.16, 1.82], P= 0.02; table 1) and increased QoL (SMD: 0.27 with 95% CI [0.03, 0.52], P= 0.03; table 1). However, there was no significant difference between BCAAs and the control group in MELD score change (MD: 0.65 with 95% CI [-1.20, 2.50], P= 0.49; table 1), skeletal muscle index change (MD: 0.21 with 95% CI [-0.23, 0.65], P= 0.35; table 1), and gait speed change (MD: 0.10 with 95% CI [-0.15, 0.34], P= 0.43; table 1).

Discussion: BCAA supplementation significantly reduced the liver frailty index, indicating a potential benefit in managing frailty. The absence of significant improvement in muscle strength, measured by hand-grip strength, may be due to the complexity of LC patients and the complexity of protein synthesis, which involves pathways beyond those influenced by BCAAs. The increase in BMI and QoL can be attributed to BCAAs' role in ammonia detoxification and improving overall metabolic function. Despite these benefits, the lack of significant changes in MELD score, skeletal muscle index, gait speed, or albumin levels suggests that while BCAAs might have some benefit in LC with sarcopenia, their overall impact on muscle mass in LC requires further investigation.



Disclosures:


Ahmed Fares, MD¹, Mohamed Abuelazm, MD², Mahmoud M.. Elhady, MBBCh³, Ahmed Mazen Amin, MBBCh⁴, Ubaid Khan, MD⁵, Ibrahim Gowaily, MBBCh², Fouad Jaber, MD, MS⁶. P4648 - Branched-Chain Amino Acids Supplementations for Sarcopenic Patients with Liver Cirrhosis: A Systematic Review and Meta-Analysis, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.