Effect of Branched-chain Amino Acid Supplementation and Exercise on Muscle Quantity and Quality in Cirrhosis

Not Applicable

Completed

Interventions: Dietary Supplement: BCAA
Other: home-based graded exercise program

Brief Summary: Introduction: Ultrasound can be used to monitor muscle mass during interventional approaches in patients with liver cirrhosis.

The aim: To investigate the effect of branched-chain amino acid (BCAA) supplementation and/or muscle exercise on ultrasound-measured quadriceps muscle thickness and echo intensity, as well as on muscle strength, performance, and nutritional assessment in patients with cirrhosis.

Patients \& Methods: This is a randomized controlled study that included 220 liver cirrhosis patients with Child-Pugh B \& C classes. They were randomized into a control group comprising 55 patients who received only the standard care, and interventional groups comprising 165 patients equally distributed into three groups, they received in addition to standard care, BCAA, programmed exercise, or BCAA and programmed exercise respectively. At baseline and after 28 days, all participants were subjected to ultrasound-measured quadriceps muscle thickness and echo intensity, in addition to handgrip strength, short physical performance battery (SPPB), anthropometric measures, hematological and biochemical assessment, MELD score measurement, nutritional assessment using 7- subjective global assessment score (SGA).

Detailed Description: This is an open, 4-arm parallel, randomized controlled trial conducted on cirrhotic patients

All eligible patients received instructions of standard care that includes standard diet and non-exercise activity thermogenesis (NEAT), then the patients were randomly assigned in an allocation ratio of approximately 1:1:1:1; group 1= control received the standard care only, and three intervention groups; group 2 received added 10 gm/day branched-chain amino acid (BCAA) (manufactured by Dulex lab company). Group 3 received added home-based exercise comprising both aerobic and resistance exercises, and finally, group 4 received added both BCAA and home-based exercise.

All patients were subjected to the following at the baseline and after 28 days:

1. thorough medical history

2. Complete clinical examination including BP, middle upper arm circumference (MUC), and body mass index (BMI) using the dry weight.

3. The nutritional status assessment using the 7-point Subjective Global Assessment (SGA) score,

4. Assessment of their physical fitness using the short physical performance battery test (SPPB) score.

5. Assessment of muscle strength using handgrip strength using a digital dynamometer (Model: 12-0286).

6. Routine labs including complete blood count (CBC), liver function, kidney function, and electrolytes, FBG

7. Calculation of Child-Pugh \& MELD scores.

8. Ultrasound assessment of quadriceps muscle thickness and echogenicity

Recruitment & Eligibility

Inclusion Criteria

Exclusion Criteria

cirrhotic patients with Child-Pugh class A, patients with acute liver cell failure or malignancies, associated other end-organ failure, and vitally unstable patients.

Arm && Interventions

Group	Intervention	Description
Group-2	BCAA	received BCAA
Group-4	BCAA	Received a combined BCAA + Exercise
Group-4	home-based graded exercise program	Received a combined BCAA + Exercise
Group-3	home-based graded exercise program	Recieved Exercice

Primary Outcome Measures

Name	Time	Method
a change from baseline of muscle strength	28 days	assessed by handgrip strength
a change from baseline of muscle quantity	28 days	assessed by ultrasound quadriceps muscle thickness
a change from baseline of muscle performance	28 days	assessed by the short physical performance battery test (SPPB)
a change from baseline of muscle quality	28 days	assessed by ultrasound quadriceps muscle echo intensity

Secondary Outcome Measures

Name	Time	Method
a change from the baseline of nutritional status	28 days	assessed by 7-point Subjective Global Assessment (SGA) score
a change from the baseline of ascites	28 days	assessed by subjective clinical grading
a change from the baseline of hematological parameters	28 days	assessed by CBC
a change from the baseline of liver enzymes	28 days	assessed by laboratory assessment of liver enzymes
a change from the baseline of MELD score	28 days	assessed by calculating MELD score at baseline and after 28 days
a change from the baseline of BP	28 days	assessed by measuring BP
a change from the baseline edema	28 days	assessed by clinical grading