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ORIGINAL ARTICLE
Year : 2014  |  Volume : 42  |  Issue : 2  |  Page : 47-52

The effect of a late-evening protein-containing snack on nitrogen balance in cirrhotic patients


1 Departments of Tropical Medicine, Tanta University, Tanta, Egypt
2 Department of Clinical Pathology, Faculty of Medicine, Tanta University, Tanta, Egypt

Correspondence Address:
Hanan A El-Bassat
Department of Tropical Medicine, Faculty of Medicine, Tanta University, Tanta
Egypt
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DOI: 10.4103/1110-1415.137797

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Purpose The aim of the study was to evaluate the effect of a late-evening protein-containing snack on nitrogen balance in cirrhotic patients. Patients and methods Thirty cirrhotic patients were divided into the following groups: group I, comprising 15 patients who received a late-evening 300-cal, 15-g protein-containing snack daily for 15 days; and group II, comprising 15 patients who received a late-evening supplement of amino acids (branched and essential) containing 22-g protein daily for 15 days. All patients were subjected to full history taking, clinical examination, and pelviabdominal ultrasound. Liver function tests, complete blood picture analysis, and estimation of blood urea and serum creatinine, urinary nitrogen loss, urea concentration in both serum and urine, and nitrogen balance were performed for all patients. Results There was a significant increase in the mean level of serum albumin and red blood cell counts. The mean nitrogen balance significantly increased in both groups but more in patients who received branched chain amino acid (BCAA) supplementation. The mean serum ammonia significantly decreased in group II patients who received a late-evening BCAA supplementation, but not in patients of group I who received a late-evening protein-containing snack. There was no statistically significant difference in the levels of serum bilirubin or fasting blood glucose in either group. Conclusion The results of the present study suggest that late-evening snacking with either a small protein-containing meal or a BCAA supplement improves the level of alanine transaminase, aspartate aminotransferase, serum albumin, nitrogen balance, ammonia, urea, and the general condition of the patient. The patients receiving BCAAs respond better than the snack group. A BCAA mixture as a late-evening snack is a favorable nutritional intervention for liver cirrhosis patients to repair hypercatabolism and sarcopenia and improve their nutritional status, such as nitrogen balance and serum albumin. These results need to be further confirmed in a larger number of patients and for a longer period of time.


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