Branched-chain-enriched amino acid solutions in patients with liver failure: an early example of nutritional...

The use of BCAA in the treatment of hepatic failure has been controversial. Even in retrospect, it is difficult to know why this controversy existed and why it has been so emotional, except for the fact that such a treatment modality has flown in the face of conventional therapy of hepatic encephalopathy, and also, probably more importantly, directly attacked some of the cherished notions of the nature of hepatic encephalopathy. Time and distance have allowed some of the controversy to die down, and as time has elapsed it has become clear that at least in the area of nutritional support of patients with hepatic failure, BCAA are the preferred alternative to treat patients who are otherwise protein intolerant. A recent unbiased review using the techniques of meta-analysis has concluded that the BCAA are efficacious for the treatment of patients with hepatic encephalopathy. Since this manuscript was completed another study has been reported. In this study, it was notable that those patients treated with oral BCAA became neurologically normal, a finding which the authors found very striking.