Agrimonia eupatoria L. (Agrimony) Extract Alters Liver Health in Subjects with Elevated Alanine Transaminase Levels: A Controlled, Randomized, and Double-Blind Trial.

Agrimonia eupatoria L. has been shown to protect against liver injury due to its lipid lowering and antioxidant activities. The aim of this research was to evaluate the effect of A. eupatoria L. aqueous extract (AEE) on 80 subjects with elevated alanine transaminase (ALT) levels in a randomized, double-blind, placebo-controlled, 8-week study. This trial was conducted between January 2013 and July 2013 at the Oriental Medical Hospital (Jecheon) of Semyung University. The trial included subjects aged 20 years or older who were diagnosed with mildly to moderately elevated ALT levels (between 45 and 135 IU/L). Subjects received two capsules of placebo or AEE twice a day for 8 weeks. Adverse events were recorded. Eighty subjects were randomized to placebo or AEE groups who had similar baseline characteristics. During the 8 weeks of treatment, 11 subjects were excluded from the analysis for protocol violation or consent withdrawal; efficacy of treatment was, therefore, evaluated in 69 subjects (placebo = 35, AEE = 34). The AEE group showed a significant reduction in ALT and serum triglyceride (TG) at 8 weeks compared with the placebo group (ALT P = .044, TG P = .020). Significant group and time interactions were found in ALT (P = .038), aspartate aminotransferase (P = .040), and TG (P = .010). Alkaline phosphatase, total bilirubin, and gamma-glutamyl transferase levels were not different between the two groups. There were no reported severe adverse events during this study, and total protein, albumin, blood urea nitrogen, creatine, and total cholesterol levels were normal in both groups. AEE consumption was safe and generally well tolerated without severe adverse events.

Protein intake in renal and hepatic disease.

The kidney and the liver play a central role in protein metabolism. Synthesis of albumin and other proteins occurs mainly in the liver, whereas protein breakdown and excretion are handled through an intricate interaction between these two organ systems. Thus, disease states of either the liver and/or the kidney invariably result in clinically relevant disturbances of protein metabolism. Conversely, metabolic processes regulated by these two organs are directly affected by dietary protein intake. Of particular importance in this respect is the maintenance of acid/base homeostasis. Finally, both the amount and composition of ingested proteins have a direct impact on renal function, especially in a state of diseased kidneys. Consequently, dietary protein intake is of paramount importance in patients with chronic nephropathy and renal insufficiency. Limitation of ingested protein, particularly from animal sources, is crucial in order to slow the progression of chronic kidney disease and impaired renal function. In contrast, patients with chronic renal failure undergoing renal replacement therapy by hemodialysis or peritoneal dialysis, have an increased protein demand. The syndrome of "protein-energy malnutrition" is a relevant factor for morbidity and mortality in this population and requires early detection and vigorous treatment. Protein intake in patients with cirrhosis of the liver should not be diminished as has been earlier suggested but rather increased to 1.0 - 1.2 g/kg body weight/day, in order to prevent protein malnutrition. Moderate restriction depending on protein tolerance (0.5 - 1.2 g/kg body weight/day), with the possible addition of branched chain amino acids (BCAA), has been recommended only in patients with advanced hepatic encephalopathy. Proteins of plant origin are theoretically superior to animal proteins.

Guidelines for specialized nutritional and metabolic support in the critically-ill patient. Update. Consensus SEMICYUC-SENPE: Liver failure and liver transplantation / Recomendaciones para el soporte nutricional y metabólico especializado del paciente crítico. Actualización. Consenso SEMICYUC-SENPE: Insuficiencia hepática y trasplante hepático

Patients with liver failure have a high prevalence ofmalnutrition, which is related to metabolic abnormalitiesdue to the liver disease, reduced nutrient intake andaltera tions in digestive function, among other factors.In general, in patients with liver failure, metabolic andnutritional support should aim to provide adequate nutrientintake and, at the same time, to contribute to patients’recovery through control or reversal of metabolic altera -tions. In critically-ill patients with liver failure, currentknowledge indicates that the organ failure is not the mainfactor to be considered when choosing the nutritionalregi men. As in other critically-ill patients, the enteralroute should be used whenever possible.The composition of the nutritional formula should beadapted to the patient’s metabolic stress.Despite the physiopathological basis classicallydescribed by some authors who consider amino acidimbalance to be a triggering factor and key element inmaintaining encephalopathy, there are insufficient datato recommend “specific” solutions (branched-chainamino acid-enriched with low aromatic amino acids) aspart of nutritional support in patients with acute liverfailure.In patients undergoing liver transplantation, nutrientintake should be started early in the postoperative periodthrough transpyloric access. Prevention of the hepatic alterations associated withnutritional support should also be considered in distinctclinical scenarios (AU)

Los pacientes con insuficiencia hepática presentan unaelevada prevalencia de malnutrición. Ésta se encuentrarelacionada, entre otros factores, con las alteraciones delmetabolismo derivadas de la enfermedad hepática, la disminución en la ingesta de nutrientes y las alteraciones enla función digestiva.De modo general, en los pacientes con insuficienciahepática, el soporte metabólico-nutricional debe tenercomo objetivo el aporte adecuado de los requerimientoscontribuyendo, al mismo tiempo, a la recuperación de lospacientes mediante el control o la reversión de las alteraciones metabólicas apreciadas. En los pacientes críticosque presentan insuficiencia hepática, los conocimientosactuales indican que ésta no parece ser un factor fundamental a la hora de considerar la pauta nutricional. Comoen otros pacientes críticos, la vía de aporte de nutrientesdebe ser la enteral, siempre que ello sea posible.La composición de la fórmula nutricional debe estaradaptada a la situación de estrés metabólico. A pesar de labase fisiopatológica, clásicamente descrita por algunosautores, que considera al disbalance de aminoácidos unfactor desencadenante y mantenedor de la encefalopatía,no hay datos suficientes para recomendar el empleo desoluciones “específicas” (enriquecidas en aminoácidosramificados y pobres en aminoácidos aromáticos) comoparte del soporte nutricional en los pacientes con insuficiencia hepática aguda.En los pacientes sometidos a trasplante hepático, elaporte de nutrientes debería iniciarse de manera precozen el postoperatorio mediante una vía de acceso transpilórica. La prevención de las alteraciones hepáticas asociadas al soporte nutricional debe ser también consideradaen diferentes situaciones clínicas (AU)