Improvement of energy substrate metabolism by late evening snack supplementation in patients with liver cirrhosis: a meta-analysis

Figures & data

Figure 1 Flow diagram of study selection.

Table 1 Characteristics of included researches

Author and year	Total patients	Age	Male	Intervention	BTR (after vs before)	FAT (after vs before)	CHO (after vs before)	Treatment period	Research type
Hiraoka et al (2017)^Citation14	33	63–71	13	BCAA a pack; once	5.24±2.04 vs 4.30±1.35	NA	NA	3 months	One-arm study
Koreeda et al (2011)^Citation15	17	46–83	11	BCAA a pack; twice	3.24±0.58 vs 2.75±0.64 (Severe group)	NA	NA	6 months	One-arm study
				4.95±1.08 vs 4.55±0.99 (Mild group)
Sakaida et al (2004)^Citation16	11	NA	NA	BCAA a pack; twice	5.31±0.51 vs 3.12±0.43	54.1±5.2 vs 66.2±4.0	33.2±4.6 vs 22.2±4.1	1 week	One-arm study
Aoyama et al (2007)^Citation17	55	48–85	34	BCAA a pack;	3.30±1.19 vs 2.67±0.92	NA	NA	3 months	One-arm study
Okamoto et al (2003)^Citation18	10	47–80	8	BCAA a pack; twice		51.7±5.8 vs 63.7±4.6	36.6±5.4 vs 25.8±4.4	1 week	One-arm study
Yamauchi et al (2001)^Citation19	14	42–72	10	BCAA a pack; twice	3.8±0.5 vs 3.5±0.4	NA	NA	2 weeks	One-arm study
Katsumi et al (2005)^Citation20	29	42–78	4	liquid nutrient a pack; twice	NA	50.1±22.5 vs 49.7±13.6	43.1±23.0 vs 42.0±13.0	1 week	RCT
			6	BCAA a pack; twice		38.2±16.1 vs 45.4±22.6	48.5±15.8 vs 41.8±21.6
			4	BCAA a pack; twice		44.5±16.1 vs 65.0±16.8	41.0±14.6 vs 24.6±17.2
Urata et al (2007)^Citation21	30	50–80	14	BCAA a pack; third	3.95±1.67 vs 3.55±2.24	43.1±16.3 vs 52.7±15.9	44.7±14.1 vs 34.6±14.6	1 week	One-arm study
Miwa et al (2000)^Citation22	12	61–65	10	Liquid nutrient a pack; once	NA	38.7±4.7 vs 54.7±4.2	47.6±4.6 vs 33.2±4.2	1 week	One-arm study

Abbreviations: BCAA, branched-chain amino acid; BTR, branched-chain amino acid/tyrosine ratio; CHO, oxidation rates for carbohydrate; FAT, oxidation rates for fat; RCT, randomized controlled trial.

Table 2 The US Agency for Healthcare Research and Quality checklist for quality assessment of one-arm research

Author, year	Define the source of information	List inclusion and exclusion criteria for exposed and unexposed participants or refer to previous publications	Indicate time period used for identifying patients	Indicate whether or not participants were consecutive if not population based	Indicate whether evaluators of subjective components of study were masked to other aspects of the status of the participants	Describe any assessments undertaken for quality assurance purposes	Explain any patient exclusions from analysis	Describe how confounding was assessed and/or controled	If applicable, explain how missing data were handled in the analysis	Summarize patient response rates and completeness of data collection	Clarify what follow-up, If any, was expected and the percentage of patients for which incomplete data or follow-up was obtained
Hiraoka et al (2017)^Citation14	Yes	Yes	Yes	Unclear	Yes	Yes	Yes	Yes	Unclear	Unclear	No
Koreeda et al (2011)^Citation15	Yes	Yes	Yes	Unclear	Yes	Yes	No	Yes	No	Unclear	No
Sakaida et al (2004)^Citation16	Yes	Yes	Yes	Unclear	Yes	Yes	No	Yes	No	Unclear	No
Aoyama et al (2007)^Citation17	Yes	Yes	Yes	Unclear	Yes	Yes	No	Yes	Yes	Unclear	No
Okamoto et al (2003)^Citation18	Yes	Yes	Yes	Unclear	Yes	Yes	No	Yes	No	Unclear	No
Yamauchi et al (2001)^Citation19	Yes	Yes	Yes	Unclear	Yes	Yes	No	Yes	No	Unclear	No
Katsumi et al (2005)^Citation20	Yes	Yes	Yes	Unclear	Yes	Yes	No	Yes	No	Unclear	No
Urata et al (2007)^Citation21	Yes	Yes	Yes	Unclear	Yes	Yes	No	Yes	Yes	Unclear	No
Miwa et al (2000)^Citation22	Yes	Yes	Yes	Unclear	Yes	Yes	No	Yes	No	Unclear	No

Figure 2 Meta-analysis of the changes in BTR. (A) Comparisons of BTR before and after LESs. (B) Subgroup analysis of the influence of different intervention periods on BTR. (C) Subgroup analysis of the effects of different daily intervention times on BTR.Abbreviations: BTR, branched-chain amino acid/tyrosine ratio; LESs, late evening snacks.

Figure 3 Meta-analysis of changes in the oxidation rate of fat. (A) Comparisons of the oxidation rate of fat before and after LESs. (B) Subgroup analysis of the effects of different interventions on fat oxidation.Abbreviation: LESs, late evening snacks.

Figure 4 Meta-analysis of changes in the oxidation rate of carbohydrate. (A) Comparisons of oxidation rate of carbohydrate before and after LESs. (B) Subgroup analysis of the effect of different interventions on the oxidation rate of carbohydrate.Abbreviation: LESs, late evening snacks.

Hiraoka A, Michitaka K, Kiguchi D, et al Efficacy of branched-chain amino acid supplementation and walking exercise for preventing sarcopenia in patients with liver cirrhosis. Eur J Gastroenterol Hepatol. 2017;29(12):1416–1423. doi:10.1097/MEG.000000000000098629016470

 PubMed Web of Science ®Google Scholar

Koreeda C, Seki T, Okazaki K, et al Effects of late evening snack including branched-chain amino acid on the function of hepatic parenchymal cells in patients with liver cirrhosis. Hepatol Res. 2011;41(5):417–422. doi:10.1111/j.1872-034X.2011.00795.x21518402

 PubMed Web of Science ®Google Scholar

Sakaida I, Tsuchiya M, Okamoto M, Okita K. Late evening snack and the change of blood glucose level in patients with liver cirrhosis. Hepatol Res. 2004;30S:67–72. doi:10.1016/j.hepres.2004.10.01015607142

 PubMed Web of Science ®Google Scholar

Aoyama K, Tsuchiya M, Mori K, et al Effect of a late evening snack on outpatients with liver cirrhosis. Hepatol Res. 2007;37(8):608–614. doi:10.1111/j.1872-034X.2007.00036.x17517075

 PubMed Web of Science ®Google Scholar

Okamoto M, Sakaida I, Tsuchiya M, et al Effect of a late evening snack on the blood glucose level and energy metabolism in patients with liver cirrhosis. Hepatol Res. 2003;27(1):45–50.12957206

 PubMed Web of Science ®Google Scholar

Yamauchi M, Takeda K, Sakamoto K, Ohata M, Toda. Effect of oral branched chain amino acid supplementation in the late evening on the nutritional state of patients with liver cirrhosis. Hepatol Res. 2001;21(3):199–204.11673104

 PubMed Web of Science ®Google Scholar

Katsumi N, Kawamura N, Yamaguchi Y, et al Effect of oral branched chain amino acid-rich nutrient administered during endoscopic injection sclerotherapy of cirrhotic patients. Hepatol Res. 2005;32(3):158–162. doi:10.1016/j.hepres.2005.03.01315970464

 PubMed Web of Science ®Google Scholar

Urata Y, Okita K, Korenaga K, et al The Geffect of supplementation with branched-chain amino acids in patients with liver cirrhosis. Hepatol Res. 2007;37(7):510–516. doi:10.1111/j.1872-034X.2007.00081.x17539993

 PubMed Web of Science ®Google Scholar

Miwa Y, Shiraki M, Kato M, et al Improvement of fuel metabolism by nocturnal energy supplementation in patients with liver cirrhosis. Hepatol Res. 2000;18(3):184–189.11058823

 PubMed Web of Science ®Google Scholar