PREFERENTIAL USE OF BRANCHED-CHAIN AMINO-ACIDS AS AN ENERGY SUBSTRATEIN PATIENTS WITH LIVER-CIRRHOSIS

We analyzed basal energy metabolism in 20 healthy volunteers and 41 ci rrhotic patients by indirect calorimetry. Subjects were then given eit her glucose, branched-chain amino acids (BCAA) or fatty acids as an en ergy substrate. Resting energy expenditure (REE), nonprotein respirato ry quotient (npRQ), and oxidation rates of glucose (% CHO), protein (% PRO) and fat (% FAT) were analyzed. REE and %FAT were significantly h igher and %CHO and %PRO were significantly lower in cirrhosis than in controls. These changes correlated with disease severity. Glucose and BCAA were utilized efficiently as energy substrates and reduced %FAT i n cirrhosis, Energy efficacy (increased energy expenditure/energy equi valent of the supplemented nutrient) was significantly higher in BCAA (96 +/- 16%) than in glucose (41 +/- 8%) (p<0.01) and fatty acids (27 +/- 13%) (p<0.05), Patients with cirrhosis have an increased energy re quirement. BCAA seems to be the preferred substrate to meet this deman d, because its energy efficacy is higher than glucose or fatty acids i n cirrhosis.