Enriched branched-chain amino acid formula versus a casein-based supplement in the treatment of cirrhosis.

An orally administered branched-chain amino acid (BCAA) rich supplement (T), Travasorb-Hepatic was compared to a casein based supplement (E), Ensure, in a randomized double-blind cross-over study in eight malnourished, stable cirrhotics unable to achieve a daily dietary protein intake of 1.0 g/kg. Doses of antiportal systemic encephalopathy drugs remained constant and a baseline 1000 kcal, 40 g dietary protein intake was encouraged. To this diet, supplemental protein was added in daily 20-g increments to a maximum of 60 g supplemental protein. Mental status, asterixis, and number connection tests were assessed daily and an antiportal systemic encephalopathy index calculated. There was no significant difference in the mean intake of dietary protein (T, 33.7 +/- 4.0 g; E, 26.7 +/- 10.8 g), supplemental protein (T, 43.1 +/- 8.3 g; E, 47.9 +/- 7.1 g), or N2 balance (T, 4.2 +/- 3.7 g; E, 3.4 +/- 4.4) between treatment trials. The antiportal systemic encephalopathy index improved on E, with no significant change in the BCAA:aromatic acid molar ratio. This ratio improved on T (1.02 +/- 2.0 to 2.7 +/- 1.1), but was not accompanied by improvement in the antiportal systemic encephalopathy index. The improved protein tolerance in both groups was not further increased by a highly enriched BCAA formula compared to one with a moderate BCAA content from a natural dietary protein source. Thus, both conventional casein-based supplements and enriched BCAA formulas are well tolerated and can be safely and effectively used as an integral part of diet therapy.

Vitamin B12 concentrations in the elderly: a regional study.

A prospective study of 100 subjects over 70 years of age residing in rest homes or geriatric wards within the Auckland region showed that 23% of the population sampled had a serum vitamin B12 concentration below the reference range. Less than half (48%) of the group with a reduced serum vitamin B12 concentration had other haematological findings on initial screening suggestive of megaloblastosis. Comparative data from hospital and community based laboratories demonstrated that 20% and 29% respectively of samples from individuals aged greater than 70 years referred for serum vitamin B12 analysis had a B12 concentration below the reference range. Reduced serum vitamin B12 abnormalities in elderly individuals should not be ignored and some guidelines for investigations with which to establish a diagnosis are presented.