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Update 9 november 2017: Bron: Nutrition january 2017 Volume 33, Pages 20–2

BCAA - branched-chain amino acid suppletie gebruikt na een RFA - radiofrequency ablation door patiënten met een nieuwe diagnose van primaire leverkanker geeft veel betere resultaten op ziektevrije tijd, overall overleving en kans op een recidief in vergelijking met gewoon eten die als controlegroep diende. Ook waren er minder ernstige complicaties en belangrijke leverwaarden waren na 1 jaar beduidend beter in de BCAA groep dan in de controlegroep. Dit blijkt uit een gerandomiseerde studie bij totaal 62 patienten waarvan er uiteindelijk 51 overbleven voor de studie. BCAA groep N = 25, Controlegroep N = 26.

BCCA na RFA van leverkanker

De studie liep over de periode 2009 t/m 2012 in het Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan. Maar sommige doelen werden al na 12 maanden vergeleken zoals bepaaldce leverwaarden.

Dit is slechts 1 studie uit de vele studies met BCAA en primaire leverkanker die vermeld staan in onze lijst niet toxische stoffen en behandelingen bij leverkanker. Alleen al bij leverkanker en levertumoren vanuit andere vormen van kanker hebben veel studies aangetoond dat BCAA suppletie een groot effect heeft op herstel van de lever na een operatie of RFA of TACE. (zie bij inleiding van overzicht BCAA) En ook als monotherapie tumoren kan doen verdwijnen. Elke goed gekwalificeerde orthomoleculaire arts  hoort te weten welke BCAA 's de juiste kwaliteit hebben en in welke doseringen voor te schrijven.

Maar deze studie is uitgevoerd bij nieuw gediagnosteerden met primaire leverkanker en dat maakt deze studie wel belangrijk en heb ik deze uitgekozen om apart te vermelden.

Want de verschillen waren echt heel groot. Zo overleden slechts 3 patiënten in de BCAA groep tegenover 10 doden in de controlegroep. En waren er veel meer ernstige complicaties na de RFA in de controlegroep in vergelijking met die in de BCAA groep.

Table 3Incidence of events
ENControlP value
Patients (n) 25 26
Death 3 10 0.03
Total events 10 18 0.036
 Rupture of varices 2 1 NS
 Ascites 6 14 0.03
 Jaundice 0 0 NS
 Hepatic encephalopathy 2 3 NS
View Table in HTML

EN, enteral nutrition; NS, not significant

Fig. 2 Opens large image

Hier nog enkele grafieken die duidelijk aangeven dat de patiënten uit de BCAA groep het in alle opzichten beter deden.

Bv bepaalde leverwaarden na 1 jaar behandeling met BCAA:

Table 2Biochemical markers pretreatment and 12 mo after treatment
BCAA (n = 25)Control (n = 26)
Pretreatment12 mo PosttreatmentPretreatment12 mo Posttreatment
RBC (×106/μL) 4.0 ± 0.5 4.22 ± 0.4∗ 4.0 ± 0.5 3.94 ± 0.4
Alb (g/dL) 3.72 ± 0.5 3.89 ± 0.5∗ 3.71 ± 0.4 3.58 ± 0.4
AST (U/L) 57.7 ± 32 51.9 ± 22 54.6 ± 22 59.9 ± 28
ALT (U/L) 46 ± 27 41.8 ± 23 48.5 ± 28 49.0 ± 31
PT (%) 79.7 ± 15 80.2 ± 16 83.6 ± 12 80.4 ± 11
FBS (mg/dL) 108 ± 30 107 ± 17 111 ± 28 109 ± 21
Child-Pugh 5.6 ± 0.8 5.4 ± 0.6 5.6 ± 0.8 5.8 ± 1.0
Lymph cell count (×103/μL) 1.2 ± 0.6 1.6 ± 0.7∗†† 1.3 ± 0.2 1.2 ± 0.4
BTR 3.5 ± 1.6 7.4 ± 4.2‡‡§ 3.5 ± 1.3 3.2 ± 1.3
Fischer ratio 2.0 ± 0.9 4 ± 2.2‡‡§ 2.0 ± 0.6 1.8 ± 0.7
View Table in HTML

Alb, albumin; ALT, alanine aminotransferase; AST, aspartate amino transferase; BTR, BCAA/L-tyrosine molar ratio; FBS, fasting blood sugar; PT, prothrombin time; RBC, red blood cells

∗P < 0.05, BCAA vs control.
†P < 0.05, 12 mo vs pretreatment.
‡P < 0.01, 12 mo vs pretreatment.
§P < 0.001, BCAA vs control.

In the BCAA group, lymphocyte counts were significantly increased 12 mo after BCAA administration was initiated (P < 0.05), whereas no such changes were observed in the control group. Thus, lymphocyte counts were significantly higher 12 mo after RFA in the BCAA group compared with the control group (P < 0.05).

Ook de optreden van een recidief was in de BCAA groep beduidend lager dan in de controlegroep:

The intrahepatic recurrence rate was significantly lower in the BCAA group than in the control group (log-rank test P = 0.036; HR, 0.402; 95% CI, 0.184–0.878; P = 0.022; Fig. 3).

Fig. 3 Opens large image

Fig. 3

The intrahepatic recurrence rate was significantly lower in the BCAA group than in the control group (P = 0.036). The number of patients without HCC recurrence at each point is shown. BCAA, branched-chain amino acid; EN, enteral nutrition; HCC, hepatocellular carcinoma; RFA, radiofrequency ablation.

Totr slot de overall overleving:

The OS was significantly higher in the BCAA group than in the control group (log-rank test P = 0.03; HR, 0.255; 95% CI, 0.068–0.953; P = 0.042; Fig. 4). Three patients from the BCAA group died (two from severe pneumonia and one from hepatic failure) as did 10 patients from the control group (1 from severe pneumonia, 8 from liver failure, and 1 from HCC; Table 3).

Fig. 4 Opens large image

Fig. 4

The overall survival rate was significantly higher in the BCAA group than in the control group (P = 0.03). BCAA, branched-chain amino acid; EN, enteral nutrition; RFA, radiofrequency ablation.

Bovenstaan is 1 studie die ik eruit heb gehaald (abstract staat onder dit artikel). Maar alleen al bij leverkanker en levertumoren vanuit andere vormen van kanker hebben veel studies aangetoond dat BCAA suppletie een groot effect heeft op herstel van de lever na een operatie of RFA of TACE. (zie bij inleiding van overzicht BCAA) En ook als monotherapie tumoren kan doen verdwijnen. Elke goed gekwalificeerde orthomoleculaire arts  hoort te weten welke BCAA 's de juiste kwaliteit hebben en in welke doseringen voor te schrijven.

In het volledige studierapport: Effects of branched-chain amino acid supplementation after radiofrequency ablation for hepatocellular carcinoma: A randomized trial dat gratis is in te zien wordt gedetailleerd beschreven hoe de studie is uitgeveord met uiteraard alle resultaten ook tot in detail weergegeven.

Hier het abstract plus referentielijst:

The present study demonstrated that BCAA administration can have a long-term inhibiting effect on carcinogenesis and can improve EFS and OS. To our knowledge, this is the first prospective trial to verify the benefits of early-stage BCAA supplementation during therapy for LC. We suggest that the BCAA therapy be used starting from the early stage of LC or chronic hepatitis, which is uncommon in current medical practice.

Effects of branched-chain amino acid supplementation after radiofrequency ablation for hepatocellular carcinoma: A randomized trial

Shunsuke Nojiri, Ph.D., M.D.'Correspondence information about the author Ph.D., M.D. Shunsuke Nojiri
,
Kei Fujiwara, Ph.D., M.D.
,
Noboru Shinkai, Ph.D., M.D.
,
Etsuko Iio, Ph.D., M.D.
,
Takashi Joh, Ph.D., M.D.
Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan

DOI: http://dx.doi.org/10.1016/j.nut.2016.07.013

Highlights

  • •To our knowledge, this is the first prospective trial to verify the benefits of early-stage branched-chain amino acid (BCAA) supplementation during therapy for liver cirrhosis.
  • •After radiofrequency ablation, Aminoleban EN may be beneficial for relieving mental stress.
  • •BCAA administration can have a long-term inhibiting effect on carcinogenesis and can improve event-free and overall survival.

Abstract

Objective

Maintenance of liver function is important for better outcomes after radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC). The aim of this study was to examine the effects of oral branched-chain amino acid (BCAA) supplementation on liver function, intrahepatic recurrence rate, and incidence of complications after RFA for HCC.

Methods

Patients with cirrhosis who underwent RFA were enrolled between August 2009 and April 2012, randomized to oral supplementation with Aminoleban EN (BCAA group) or diet alone (control group), and followed to determine changes in serum parameters and health status. Patients in the BCAA group were instructed to ingest a packet of Aminoleban EN twice daily. Levels of physical and mental stress were assessed using the Short Form-8 health survey. Oral BCAA and dietary interventions were initiated 2 wk before local therapy, and contrast-enhanced computed tomography was performed every 3 mo to assess recurrence.

Results

We evaluated 25 patients in the BCAA group and 26 in the control group. The median follow-up period was 3.9 y (736–1818 d). There were no significant differences between the two groups in basal characteristics. Complications were less frequent in the BCAA group (P = 0.03). Event-free survival was significantly higher in the BCAA group, whereas the intrahepatic recurrence rate was significantly lower (P = 0.04 and 0.036, respectively). A significant improvement in the Short Form-8 mental component score was observed in the BCAA group only (P < 0.01).

Conclusion

Aminoleban EN may be beneficial for cirrhotic patients after RFA to relieve mental stress and reduce the risks for intrahepatic recurrence and complications.

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The authors have no conflicts of interest to declare.

© 2016 Elsevier Inc. All rights reserved.

levertumoren, primaire leverkanker, HCC, bijwerkingen, overall overleving, RFA radiofrequency ablation, kans op recidief, ziektevrije overleving, BCAA branched-chain amino acid


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