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Long-term Therapy With a Branched-Chain Amino-Acid-Enriched Elemental Diet

Herbert Freund, MD; Norman Yoshimura, PhD; Josef E. Fischer, MD

JAMA. 1979;242(4):347-349.

Abstract
Therapy of chronic hepatic encephalopathy is often frustrating, limited as it is by the ability to adequately nourish such patients. Protein is needed for repair, but such patients are intolerant of protein. Previous work from this and other laboratories has suggested that the distorted plasma amino acid pattern may be causally related to hepatic encephalopathy. A single, well-studied, long-term patient received therapy with a branched-chain amino-acid—enriched elemental diet that not only enabled adequate nutrition with protein but resulted in improvement in hepatic function as well as reversal of some aspects of hepatic encephalopathy that heretofore have been deemed irreversible. The results confirm that branched-chain—enriched amino acid diets previously successful in the intravenous mode may be successfully used in chronic long-term support of patients with protein intolerance, with improvement in hepatic function secondary to improvement in nutrition.

(JAMA 242:347-349, 1979)

Author Affiliations
From the Department of Surgery, Massachusetts General Hospital (Drs Freund and Fischer), and Harvard Medical School, Boston (Drs Freund and Fischer), and McGaw Laboratories, Irvine, Calif (Dr Yoshimura).

Footnotes
Reprint requests to Department of Surgery, University of Cincinnati Medical Center, 231 Bethesda Ave, Cincinnati, OH 45267 (Dr Fischer).

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