Branched-Chain Amino Acid Supplements for Sarcopenia in Liver Cirrhosis: A Systematic Review and Meta-analysis

Sarcopenia, a key aspect of malnutrition in liver cirrhosis (LC), affects 30-70% of LC patients. Given the inconsistent results from RCTs on branched-chain amino acids (BCAAs) for treating sarcopenia in LC, we conducted a systematic review and meta-analysis to assess the efficacy and safety of BCAAs for sarcopenia management in LC patients.

A systematic review and meta-analysis synthesizing evidence from 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.

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). 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). Also, BCAAs were associated with increased body mass index (BMI) change (MD: 0.99 with 95% CI [0.16, 1.82], P = 0.02) and increased QoL (standardized mean difference : 0.27 with 95% CI [0.03, 0.52], P = 0.03). However, there was no significant difference between BCAAs and the control group in model for end-stage liver disease (MELD) score change (MD: 0.65 with 95% CI [-1.20, 2.50], P = 0.49), skeletal muscle index change (MD: 0.21 with 95% CI [-0.23, 0.65], P = 0.35), and gait speed change (MD: 0.10 with 95% CI [-0.15, 0.34], P = 0.43).

BCAA supplementation in cirrhotic patients with sarcopenia reduced the liver frailty index, increased BMI and QoL, but did not affect handgrip strength, skeletal muscle index, gait speed, or MELD score. Outcome heterogeneity and study bias were noted, highlighting the need for further RCTs to confirm these results.