Amino Acids

, Volume 40, Issue 4, pp 1213–1220 | Cite as

Oral supplementation with carbohydrate- and branched-chain amino acid-enriched nutrients improves postoperative quality of life in patients undergoing hepatic resection

  • Takehiro OkabayashiEmail author
  • Miho Iyoki
  • Takeki Sugimoto
  • Michiya Kobayashi
  • Kazuhiro Hanazaki
Original Article


The long-term outcomes of branched-chain amino acid (BCAA) administration in patients undergoing hepatic resection remain unclear. The aim of this study is to assess the impact of oral supplementation with BCAA-enriched nutrients on postoperative quality of life (QOL) in patients undergoing liver resection. A prospective randomized clinical trial was conducted in 96 patients undergoing hepatic resection. Patients were randomly assigned to receive BCAA supplementation (AEN group, n = 48) or a conventional diet (control group, n = 48). Postoperative QOL and short-term outcomes were regularly and continuously evaluated in all patients using a short-form 36 (SF-36) health questionnaire and by measuring various clinical parameters. This study demonstrated a significant improvement in QOL after hepatectomy for liver neoplasm in the AEN group based on the same patients’ preoperative SF-36 scores (P < 0.05). Perioperative BCAA supplementation preserved liver function and general patient health in the short term for AEN group patients compared to those not receiving the nutritional supplement. BCAA supplementation improved postoperative QOL after hepatic resection over the long term by restoring and maintaining nutritional status and whole-body kinetics. This study was registered at (registration number: NCT00945568).


Branched-chain amino acids Carbohydrate Quality of life Hepatectomy Nutrition 



This study was supported by the Ministry of Education, Culture, Sports, Science, and Technology, The Uehara Memorial Foundation, and the Kochi University Discretionary Fund.


  1. Alberino F, Gatta A, Amodio P, Merkel C, Di Pascoli L, Boffo G et al (2001) Nutrition and survival in patients with liver cirrhosis. Nutrition 17:445–450PubMedCrossRefGoogle Scholar
  2. Banz VM, Inderbitzin D, Fankhauser R, Studer P, Candinas D (2009) Long-term quality of life after hepatic resection: health is not simply the absence of disease. World J Surg 33:1473–1480PubMedCrossRefGoogle Scholar
  3. Bianchi G, Marzocchi R, Agostini F, Marchesini G (2005) Update on branched-chain amino acid supplementation in liver diseases. Curr Opin Gastroenterol 21:197–200PubMedCrossRefGoogle Scholar
  4. Blei AT, Cordoba J (2001) Hepatic encephalopathy. Am J Gastroenterol 96:1968–1976PubMedCrossRefGoogle Scholar
  5. Caregaro L, Alberino F, Amodio P, Merkel C, Bolognesi M, Angeli P et al (1996) Malnutrition in alcoholic and virus-related cirrhosis. Am J Clin Nutr 63:602–609PubMedGoogle Scholar
  6. Giovannini I, Chiarla C, Giuliante F, Vellone M, Ardito F, Nuzzo G (2006) The relationship between albumin, other plasma proteins and variables, and age in the acute phase response after liver resection in man. Amino Acids 31:463–469PubMedCrossRefGoogle Scholar
  7. Ikegami N, Drummond M, Fukuhara S, Nishimura S, Torrance GW, Scubert F (2002) Why has the use of health economic evaluation in Japan lagged behind that in other development countries? Pharmacoeconomics 20:1–7PubMedCrossRefGoogle Scholar
  8. Kogo M, Kano A, Kiuchi Y, Mitamura K, Yoneyama K (2007) Prognostic index for survival in patients after treatment for primary hepatocellular carcinoma. Dig Dis Sci 52:2444–2451PubMedCrossRefGoogle Scholar
  9. Lautz HU, Selberg O, Korber J, Burger M, Muller MJ (1992) Protein-calorie malnutrition in liver cirrhosis. Clin Invest 70:478–486CrossRefGoogle Scholar
  10. Lee LJ, Chen CH, Yao G, Chung CW, Sheu JC, Lee PH et al (2007) Quality of life in patients with hepatocellular carcinoma received surgical resection. J Surg Oncol 95:34–39PubMedCrossRefGoogle Scholar
  11. Marchesini G, Bianchi G, Merli M, Amodio P, Panella C, Loguercio C et al (2003) Italian BCAA Study Group. Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial. Gastroenterology 124:1792–1801PubMedCrossRefGoogle Scholar
  12. Marchesini G, Marzocchi R, Noia M, Bianchi G (2005) Branched-chain amino acid supplementation in patients with liver diseases. J Nutr 135:1596S–1601SPubMedGoogle Scholar
  13. Meng WC, Leung KL, Ho RL, Leung TW, Lau WY (1999) Prospective randomized control study on the effect of branched-chain amino acids in patients with liver resection for hepatocellular carcinoma. Aust NZ J Surg 69:811–815CrossRefGoogle Scholar
  14. Miwa Y, Moriwaki H (2004) Nocturnal energy and BCAA supplementation in patients with liver cirrhosis. Hepatol Res 30S:63–66PubMedCrossRefGoogle Scholar
  15. Moriwaki H, Miwa Y, Tajika M, Kato M, Fukushima H, Shiraki M (2004) Branched-chain amino acids as a protein- and energy-source in liver cirrhosis. Biochem Biophys Res Commun 313:405–409PubMedCrossRefGoogle Scholar
  16. Ogata S, Belghiti J, Varma D, Sommacale D, Maeda A, Dondero F et al (2007) Two hundred liver hanging maneuvers for major hepatectomy: a single-center experience. Ann Surg 245:31–35PubMedCrossRefGoogle Scholar
  17. Okabayashi T, Nishimori I, Sugimoto T, Maeda H, Dabanaka K, Onishi S et al (2008a) Effects of branched-chain amino acids-enriched nutrient support for patients undergoing liver resection for hepatocellular carcinoma. J Gastroenterol Hepatol 23:1869–1873PubMedCrossRefGoogle Scholar
  18. Okabayashi T, Nishimori I, Sugimoto T, Iwasaki S, Akisawa N, Maeda H et al (2008b) The benefit of the supplementation of perioperative branched-chain amino acids in patients with surgical management for hepatocellular carcinoma: a preliminary study. Dig Dis Sci 53:204–209PubMedCrossRefGoogle Scholar
  19. Okabayashi T, Nishimori I, Yamashita K, Sugimoto T, Namikawa T, Maeda H et al (2010) Preoperative oral supplementation with carbohydrate and branched-chain amino acid-enriched nutrient improves insulin resistance in patients undergoing a hepatectomy: a randomized clinical trial using an artificial pancreas. Amino Acids 38:901–907PubMedCrossRefGoogle Scholar
  20. Pacella CM, Francica G, Di Lascio FM, Arienti V, Antico E, Caspani B et al (2009) Long-term outcome of cirrhotic patients with early hepatocellular carcinoma treated with ultrasound-guided percutaneous laser ablation: a retrospective analysis. J Clin Oncol 27:2615–2621PubMedCrossRefGoogle Scholar
  21. Poon RT, Fan ST, Yu WC, Lam BK, Chan FY, Wong J (2001) A prospective longitudinal study of quality of life after resection of hepatocellular carcinoma. Arch Surg 136:693–699PubMedCrossRefGoogle Scholar
  22. Poon RT, Fan ST, Lo CM, Liu CL, Lam CM, Yuen WK et al (2004) Improving perioperative outcome expands the role of hepatectomy in management of benign and malignant hepatobiliary diseases: analysis of 1222 consecutive patients from a prospective database. Ann Surg 240:698–708PubMedGoogle Scholar
  23. Richter S, Kollmar O, Schuld J, Moussavian MR, Igna D, Schilling MK (2009) Chirurgische Arbeitsgemeinschaft OP-Technik und OP-Strukturen (CAOP) of the Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie. Randomized clinical trial of efficacy and costs of three dissection devices in liver resection. Br J Surg 96:593–601PubMedCrossRefGoogle Scholar
  24. Sajid MS, Iftikhar M, Rimple J, Baig MK (2008) Use of health-related quality of life tools in hepatobiliary surgery. Hepatobiliary Pancreat Dis Int 7:135–137PubMedGoogle Scholar
  25. Tajika M, Kato M, Mohri H, Miwa Y, Kato T, Ohnishi H et al (2002) Prognostic value of energy metabolism in patients with viral liver cirrhosis. Nutrition 18:229–234PubMedCrossRefGoogle Scholar
  26. The San-in Group of Liver Surgery (1997) Long-term oral administration of branched chain amino acids after curative resection of hepatocellular carcinoma: a prospective randomized trial. Br J Surg 84:1525–1531Google Scholar
  27. Tomiya T, Omata M, Fujiwara K (2004) Significance of branched chain amino acids as possible stimulators of hepatocyte growth factor. Biochem Biophys Res Commun 313:411–416PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Takehiro Okabayashi
    • 1
    Email author
  • Miho Iyoki
    • 2
  • Takeki Sugimoto
    • 1
  • Michiya Kobayashi
    • 1
  • Kazuhiro Hanazaki
    • 1
  1. 1.Department of SurgeryKochi Medical SchoolKochiJapan
  2. 2.Nutrition Support Team at Kochi Medical SchoolKochiJapan

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