Efficacy of branched-chain amino acid supplementation and walking exercise for preventing sarcopenia in patients with liver cirrhosis

Eur J Gastroenterol Hepatol. 2017 Dec;29(12):1416-1423. doi: 10.1097/MEG.0000000000000986.


Background/aim: Sarcopenia is recognized as a condition related to quality of life and prognosis in patients with chronic liver disease, although no useful strategy for improving muscle volume and strength has been established. Here, we evaluated the efficacy of supplementation with branched-chain amino acid (BCAA) administration and walking exercise.

Patients and methods: From December 2015 to July 2016, 33 Japanese outpatients with liver cirrhosis were enrolled (median: 67 years, HCV : HBV : alcohol : others=26 : 2 : 2 : 3, male : female=13 : 20, Child-Pugh A : B=30 : 3). None had a history of BCAA supplementation. After calculating the average number of daily steps using a pedometer for a 2-3-week period, BCAA supplementation (protein 13.5 g, 210 kcal/day) as a late evening snack and walking exercise (additional 2000 steps/day prescribed) were started. Body composition including muscle volume was analyzed using a bioelectrical impedance analysis method, and serological data and muscle strength (leg, handgrip) were evaluated at enrollment, and then 1, 2, and 3 months after starting the protocol.

Results: The median average number of daily steps was 3791 (interquartile range: 2238-5484). The average period of BCAA supplementation was 2.7±0.7 months. During the period from enrollment to 3 months after starting the protocol, HbA1c and NH3 were not significantly changed, whereas the BCAA/tyrosine ratio improved (4.3±1.35 to 5.24±2.04, P=0.001). In addition, the ratios for average daily steps (1.595, P=0.02) as well as muscle volume, leg strength, and handgrip strength (1.013, 1.110, and 1.056, respectively; all P<0.01) were increased at 3 months.

Conclusion: BCAA supplementation and walking exercise were found to be effective and easily implemented for improving muscle volume and strength in liver cirrhosis patients.

MeSH terms

  • Aged
  • Amino Acids, Branched-Chain / blood
  • Amino Acids, Branched-Chain / therapeutic use*
  • Ammonia / blood
  • Body Composition
  • Dietary Supplements*
  • Exercise Test
  • Exercise Therapy
  • Female
  • Glycated Hemoglobin A / metabolism
  • Hand Strength
  • Humans
  • Liver Cirrhosis / blood
  • Liver Cirrhosis / complications*
  • Lower Extremity / physiopathology
  • Male
  • Middle Aged
  • Muscle, Skeletal / pathology*
  • Organ Size
  • Sarcopenia / blood
  • Sarcopenia / etiology
  • Sarcopenia / prevention & control*
  • Tyrosine / blood
  • Walking / physiology*


  • Amino Acids, Branched-Chain
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human
  • Tyrosine
  • Ammonia