The effect of L-ornithine L-aspartate and branch chain amino acids on encephalopathy and nutritional status in liver cirrhosis with malnutrition

Abstract

Aim: to determine the effect of L-ornithine-L-aspartate (LOLA) together with the nutritional improvement and branched chain amino acids (BCAAs) substitution, on encephalopathy in liver cirrhosis with malnutrition.

Methods: liver cirrhosis patients visited Cipto mangunkusumo Hospital in June-October 2009 were evaluated by critical flicker frequency (CFF) test. Encephalopathy is defined when CFF <39 Hz. Nutritional status is measured by the mid-arm muscle circumference (MAMC) and is stated as malnutrition when MAMC <15%. All subjects who fulfilled the inclusion criteria received education for adequate calories and protein intake, and then they were be divided into 2 groups by randomization. One group was given LOLA granules 3 x 6 g/d for 2 weeks, while another group was not. Then their prealbumin and CFF test were measured again. Statistical analysis conducted for this double blind randomized clinical trial was independent student t test.

Results: there were 34 liver cirrhosis patients fit the inclusion criteria, and by randomization 17 subjects were put into group A (received LOLA) and 17 subjects into group B (without LOLA). Statistical analysis obtained the statistically significant (p=0,016) of increasing of the mean CFF value in group A (2.41 ± 1.6 Hz) compared to group B (0.67 ± 2.3 Hz). However, there was not significant increasing of prealbumin level in group A compared to group B (1 ± 1.3 mg/dL vs 1.2 ± 1.4 mg/dL, respectively (p=0,59). Furthermore, after 2 weeks of treatment there was no significant increase of ureum and creatinine level in both groups (4 ± 0.5 mg/dL vs 9.3 ± 1.3 mg/dL, (p=0.4) for ureum, -0.1 (0.1) mg/dL vs 0.1 ± 0.1 mg/dL, (p=0.3) for creatinine.

Conclusion: minimal hepatic encephalopathy with malnutrition can be given a diet of 35-40 cal/kgBW and 1.5 g protein/kgBW including BCAA substitution to improve nutritional status, and LOLA granules can be given to improve encephalopathy.