Taste Impairment and Compliance Improvement of Branched-Chain Amino Acids in Patients with Liver Cirrhosis

Background: Branched-chain amino acids (BCAA) are nutrients with a bitter taste, which causes low compliance in patients who need BCAA supplementation. Moreover, chronic liver disease is frequently complicated by taste impairment. The present study was designed to improve patient noncompliance regarding nutrients in liver disease. Methods: A taste questionnaire was administered to healthy controls, chronic hepatitis patients, and cirrhotic patients. Eleven different flavored powders that can be added to BCAA nutrients to reduce their unpleasant taste and smell were evaluated and categorized into three groups: delicious, fair and not good to drink. Patient serum zinc levels were measured and analyzed regarding their relationship to taste dysfunction. Results: Twenty-two healthy controls, 11 chronic hepatitis patients, and 36 liver cirrhosis patients were enrolled. Of the study subjects, 81.8% of healthy controls, 72.7% of chronic hepatitis patients and 50% of liver cirrhosis patients reported that a usual meal was delicious. The fruit-derived flavor and the yogurt flavor were well liked among each group. The mean serum zinc value of liver cirrhosis patients (53.7 g/dl) was significantly lower than that of chronic hepatitis patients (69.6 g/dl, P < 0.01). Conclusions: Half of the cirrhotic patients were dissatisfied with the taste of the usual meal. Zinc deficiency could be one cause of taste dysfunction and poor appetite in chronic liver disease. Flavors derived from fruits, which provide acidity and sweetness to counteract the taste of the BCAA nutrients, could improve palatability of BCAA supplementation for patients with liver disease.