Title: Branched-chain Amino Acids Supplementation Improves Liver Frailty Index in Frail
Compensated Cirrhotic Patients: A Randomized Controlled Trial
Version: 2 Date: 26 Mar 2023
Reviewer's report:
This open-labeled randomized controlled trial was conducted to evaluate the efficacy of 16
weeks of branched-chain amino acids (BCAA) supplementation for cirrhotic patients with
frailty, defined by liver frailty index (LFI) #4.5. A total of 54 patients (Child-Pugh, class
A 68.5% and class B, 31.5%) were randomly assigned in a 1:1 ratio to receive twice daily
BCAAs supplementation (210 kcal, protein 13.5 g, BCAA 2.03 g) versus no nutritional
supplementation for 16 weeks. The authors found that the proportion of frailty reversion at week
16 was significantly higher in the BCAA group compared to the control group (36% vs. 0%).
They concluded that a 16-week BCAA supplementation improved frailty in frail compensated
cirrhotic patients. This manuscript is well-written and provides insights into the management of
cirrhotic patients. I had some suggestions that would help clarify this study.
1. What specific treatments are available for certain liver diseases, such as alcoholism and
chronic viral hepatitis infection? These management practices may have an impact on the
outcome of this study.
2. To compare changes over the 16 weeks of intervention, repeated-measures ANOVA should
be used, with the outcomes assessed in the study as the dependent variable and time, study group,
and time-by-group interaction as the independent variables.
3. For a small sample size, the absolute changes (delta) in clinical and laboratory parameters at
baseline and week 16 are clinically insignificant. To compare the differences between the two
groups, a non-parametric test should be used.
4. The compliance data for each arm should be provided in the results section.
5. Given that there was an improvement in BMI and serum albumin with BBCA supplementation
compared to control, it is unclear why no improvement in SMI was observed between the BCAA
and control groups.
6. Since the nutritional formula used in the interventional arm of the study contains calories
from carbohydrates, fat, and BBCA as a protein source, it is difficult to determine whether the
positive effects of the study intervention are attributable to BBCA supplementation or nutritional
improvement. This should be emphasized in the study's limitations.
Title: Branched-chain Amino Acids Supplementation Improves Liver Frailty Index in Frail
Compensated Cirrhotic Patients: A Randomized Controlled Trial
Version: 2 Date: 26 Mar 2023
Reviewer's report:
This open-labeled randomized controlled trial was conducted to evaluate the efficacy of 16
weeks of branched-chain amino acids (BCAA) supplementation for cirrhotic patients with
frailty, defined by liver frailty index (LFI) #4.5. A total of 54 patients (Child-Pugh, class
A 68.5% and class B, 31.5%) were randomly assigned in a 1:1 ratio to receive twice daily
BCAAs supplementation (210 kcal, protein 13.5 g, BCAA 2.03 g) versus no nutritional
supplementation for 16 weeks. The authors found that the proportion of frailty reversion at week
16 was significantly higher in the BCAA group compared to the control group (36% vs. 0%).
They concluded that a 16-week BCAA supplementation improved frailty in frail compensated
cirrhotic patients. This manuscript is well-written and provides insights into the management of
cirrhotic patients. I had some suggestions that would help clarify this study.
1. What specific treatments are available for certain liver diseases, such as alcoholism and
chronic viral hepatitis infection? These management practices may have an impact on the
outcome of this study.
2. To compare changes over the 16 weeks of intervention, repeated-measures ANOVA should
be used, with the outcomes assessed in the study as the dependent variable and time, study group,
and time-by-group interaction as the independent variables.
3. For a small sample size, the absolute changes (delta) in clinical and laboratory parameters at
baseline and week 16 are clinically insignificant. To compare the differences between the two
groups, a non-parametric test should be used.
4. The compliance data for each arm should be provided in the results section.
5. Given that there was an improvement in BMI and serum albumin with BBCA supplementation
compared to control, it is unclear why no improvement in SMI was observed between the BCAA
and control groups.
6. Since the nutritional formula used in the interventional arm of the study contains calories
from carbohydrates, fat, and BBCA as a protein source, it is difficult to determine whether the
positive effects of the study intervention are attributable to BBCA supplementation or nutritional
improvement. This should be emphasized in the study's limitations.
Please review this paper.
user
Title: Branched-chain Amino Acids Supplementation Improves Liver Frailty Index in Frail
Compensated Cirrhotic Patients: A Randomized Controlled Trial
Version: 2 Date: 26 Mar 2023
Reviewer's report:
This open-labeled randomized controlled trial was conducted to evaluate the efficacy of 16
weeks of branched-chain amino acids (BCAA) supplementation for cirrhotic patients with
frailty, defined by liver frailty index (LFI) #4.5. A total of 54 patients (Child-Pugh, class
A 68.5% and class B, 31.5%) were randomly assigned in a 1:1 ratio to receive twice daily
BCAAs supplementation (210 kcal, protein 13.5 g, BCAA 2.03 g) versus no nutritional
supplementation for 16 weeks. The authors found that the proportion of frailty reversion at week
16 was significantly higher in the BCAA group compared to the control group (36% vs. 0%).
They concluded that a 16-week BCAA supplementation improved frailty in frail compensated
cirrhotic patients. This manuscript is well-written and provides insights into the management of
cirrhotic patients. I had some suggestions that would help clarify this study.
1. What specific treatments are available for certain liver diseases, such as alcoholism and
chronic viral hepatitis infection? These management practices may have an impact on the
outcome of this study.
2. To compare changes over the 16 weeks of intervention, repeated-measures ANOVA should
be used, with the outcomes assessed in the study as the dependent variable and time, study group,
and time-by-group interaction as the independent variables.
3. For a small sample size, the absolute changes (delta) in clinical and laboratory parameters at
baseline and week 16 are clinically insignificant. To compare the differences between the two
groups, a non-parametric test should be used.
4. The compliance data for each arm should be provided in the results section.
5. Given that there was an improvement in BMI and serum albumin with BBCA supplementation
compared to control, it is unclear why no improvement in SMI was observed between the BCAA
and control groups.
6. Since the nutritional formula used in the interventional arm of the study contains calories
from carbohydrates, fat, and BBCA as a protein source, it is difficult to determine whether the
positive effects of the study intervention are attributable to BBCA supplementation or nutritional
improvement. This should be emphasized in the study's limitations.
assistant