How to select BCAA preparations

Abstract

In Japan, oral branched-chain amino acid (BCAA) preparations are used in nutritional therapy for correcting disorders of protein and amino acid metabolism in patients with liver cirrhosis. There are two forms of oral BCAA preparations: enteral nutrition products for liver failure (or elemental nutrition products for liver cirrhosis) and oral BCAA granular products. Granular products are indicated for patients with uncompensated liver cirrhosis who have no dietary restriction and hypoproteinemia. Enteral nutrition products are indicated for patients who have a history of hepatic encephalopathy and exhibit protein intolerance. In clinical practice, the existence of protein intolerance in patients with uncompensated liver cirrhosis should be determined based on a history of hepatic encephalopathy and blood ammonia concentration. When patients exhibit protein intolerance, they are given a low protein diet (approximately 0.5-1.0g/kg/day) with enteral nutrition products for liver failure. However, when patients consume adequate amounts of a well-balanced diet and ammonia concentration does not increase, it is possible to control their condition with granular products. However, when patients cannot achieve an adequate dietary intake, it is recommended that enteral nutrition products should be used in order to improve nutritional status, even if these patients do not have a history of encephalopathy.