The effect of L-ornithine L-aspartate and branch chain amino acids on encephalopathy and nutritional status in liver cirrhosis with malnutrition.

AIM to determine the effect of L-ornithine-L-aspartate (LOLA) together with the nutritional improvement and branched chain amino acids (BCAAs) substitution, on encephalopathy in liver cirrhosis with malnutrition. METHODS liver cirrhosis patients visited Cipto mangunkusumo Hospital in June-October 2009 were evaluated by critical flicker frequency (CFF) test. Encephalopathy is defined when CFF <39 Hz. Nutritional status is measured by the mid-arm muscle circumference (MAMC) and is stated as malnutrition when MAMC <15%. All subjects who fulfilled the inclusion criteria received education for adequate calories and protein intake, and then they were be divided into 2 groups by randomization. One group was given LOLA granules 3 x 6 g/d for 2 weeks, while another group was not. Then their prealbumin and CFF test were measured again. Statistical analysis conducted for this double blind randomized clinical trial was independent student t test. RESULTS there were 34 liver cirrhosis patients fit the inclusion criteria, and by randomization 17 subjects were put into group A (received LOLA) and 17 subjects into group B (without LOLA). Statistical analysis obtained the statistically significant (p=0,016) of increasing of the mean CFF value in group A (2.41 ± 1.6 Hz) compared to group B (0.67 ± 2.3 Hz). However, there was not significant increasing of prealbumin level in group A compared to group B (1 ± 1.3 mg/dL vs 1.2 ± 1.4 mg/dL, respectively (p=0,59). Furthermore, after 2 weeks of treatment there was no significant increase of ureum and creatinine level in both groups (4 ± 0.5 mg/dL vs 9.3 ± 1.3 mg/dL, (p=0.4) for ureum, -0.1 (0.1) mg/dL vs 0.1 ± 0.1 mg/dL, (p=0.3) for creatinine. CONCLUSION minimal hepatic encephalopathy with malnutrition can be given a diet of 35-40 cal/kgBW and 1.5 g protein/kgBW including BCAA substitution to improve nutritional status, and LOLA granules can be given to improve encephalopathy.