COMPARING THE EFFECTS OF WHEY AND CASEIN SUPPLEMENTATION ON NUTRITIONAL STATUS AND IMMUNE PARAMETERS IN PATIENTS WITH CHRONIC LIVER DISEASE - A RANDOMIZED DOUBLE-BLIND CONTROLLED TRIAL.

Protein supplementation may be beneficial for patients with chronic liver disease (CLD). This study compared the effects of whey protein isolate (WP) and casein (CA) supplementation on nutritional status and immune parameters of CLD patients who were randomly assigned to take 20 g of WP or CA twice a day as a supplement for 15 days. Body composition, muscle functionality and plasmatic immunomarkers were assessed before and after supplementation. Patients were also classified according to the model for end-stage liver disease (MELD) into less (MELD <15) and more (MELD≥15) more severe disease groups. Malnutrition, determined by the Subjective Global Assessment at baseline, was observed in 57.4% and 54.2% of patients in the WP and CA groups, respectively (p=0.649). Protein intake was lower at baseline in the WP group than in the CA group (p=0.035), with no difference after supplementation (p=0.410). Both the WP and CA MELD<15 groups increased protein intake after supplementation according to intragroup analysis. No differences were observed in body composition, muscle functionality, most plasma cytokines (TNF, IL-6, IL-1β and IFN-γ), immunomodulatory proteins (sTNFR1, sTNFR2, BDNF and GDNF), or immunomodulatory hormones (adiponectin, insulin, and leptin) after supplementation in the WP groups at the two assessed moments. WP supplementation increased the levels of IP-10/CXCL10 (p=0.022), eotaxin-1/CCL11 (p=0.031) and MCP-1/CCL2 (p=0.018) and decreased IL-5 (p=0.027), including among those in the MELD≥15 group, for whom IL-10 was also increased (p=0.008). Thus, WP consumption by patients with CLD impacted the immunomodulatory responses when compared to CA with no impact on nutritional status.