Late Evening Snack, Branched Chain Amino Acids, and Cirrhosis

Patients with liver cirrhosis (LC) have decreased gluconeogenic capacity, which leads to decreased availability of sugar and increased availability of fat especially during the fasting period from after the evening meal until morning. Furthermore, due to gluconeogenesis requirements for amino acids being met by the breakdown of muscle protein, skeletal muscle is decreased and the nitrogen balance becomes negative. Thus, patients with LC present with protein energy malnutrition (PEM).Branched chain amino acid (BCAA) therapy for LC is effective for ameliorating this condition by correcting PEM and improving both quality of life (QOL) and prognosis. A late evening snack (LES) using Aminoleban EN for LC has beneficial effects on hepatic parenchymal cells in addition to nutritional effects. A LES using BCAA is both safe and useful, as nutritional and dietary therapy, comprising one part of the four-meal-a-day dietary intervention.