Late evening snack with Branched-Chain AminoAcids Supplementation improves survival in patients with Cirrhosis


Late evening snack with Branched-Chain
AminoAcids Supplementation improves
survival in patients with Cirrhosis
Tatsunori Hanai, Makoto Shiraki, Kenji Imai,
Atsushi Suetsugu, Koji Takai, Masahito Shimizu

Abstract: The clinical efficacy of a late evening snack (LES) is well documented in patients with cirrhosis, but its effect on survival remains unclear. This cohort study aimed to compare the overall survival between LES-treated patients and untreated patients. We conducted a retrospective cohort study to determine the effect of LES, which is defined as an oral intake of a branched-chain amino acids (BCAA)-enriched nutrient before bedtime, on survival in 523 patients with cirrhosis seen at a tertiary referral center in Japan from March 2004 to April 2019. The association between LES and all-cause mortality was evaluated using propensity score matching and inverse probability of treatment weighting analyses. The median age of the 523 participants was 66 years; 286 (55%) patients were men and 87 (17%) received LES therapy. Of the 231 propensity-matched patients, 20 (26%) LES-treated patients and 72 (47%) untreated patients died during a median follow-up of 2.0 years (interquartile range, 0.5–4.8). Propensity score matching analysis showed that the overall survival was significantly higher in LES-treated patients than in untreated patients (hazard ratio [HR], 0.57; 95% confidence interval [CI], 0.34–0.93). The survival benefit of LES therapy was most prominent inpatients with Child–Pugh C cirrhosis (HR, 0.40; 95% CI, 0.20–0.81). Inverse probability of treatment weighting analysis also revealed that LES significantly improved the prognosis of patients with cirrhosis (HR, 0.57; 95% CI, 0.33–0.99). In this retrospective study of patients with cirrhosis, we found that nocturnal BCAA supplementation was associated with a significant reduction in the risk of death in patients with liver cirrhosis.

Conclusions: Nocturnal BCAA supplementation can improve the prognosis of patients with cirrhosis, especially those with advanced cirrhosis. Overall, our findings suggest that a LES is most likely clinically beneficial for patients with cirrhosis.

KEYWORDS: branched-chain amino acids; cirrhosis; late evening snack; liver failure; malnutrition; Nutritional supplementation; survival with a high risk of malnutrition.

Supplementary Materials: Available online at,

Ref: J. Clin. Med. 2020, 9, 1013; doi:10.3390/jcm9041013

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