Are Supplemental Branched-Chain Amino Acids Beneficial During the Oncological Peri-Operative Period: A Systematic Review and Meta-Analysis.
branched-chain amino acids
cancer
enhanced recovery after surgery
isoleucine
leucine
liver
nutritional supplements
post-operative complications
surgery
valine
Journal
Integrative cancer therapies
ISSN: 1552-695X
Titre abrégé: Integr Cancer Ther
Pays: United States
ID NLM: 101128834
Informations de publication
Date de publication:
Historique:
entrez:
2
3
2021
pubmed:
3
3
2021
medline:
12
10
2021
Statut:
ppublish
Résumé
Branched-chain amino acids (BCAAs; leucine, isoleucine, and valine) are essential amino acids involved in immune responses, and may have roles in protein malnutrition and sarcopenia. Furthermore, certain liver diseases have been associated with a decreased Fischer's ratio (BCAAs to aromatic amino acids; phenylalanine, tyrosine, and tryptophan). We aimed to evaluate the safety and efficacy of BCAAs use in patients with cancer undergoing surgery. MEDLINE, Embase, and CENTRAL were searched (inception to July 24, 2020) for randomized controlled trials (RCTs) and comparative observational studies in English evaluating BCAAs (alone or in combinations) during the oncological peri-operative period. Study selection, data extraction, and quality appraisal were done in duplicate. RCT risk-of-bias was appraised using Cochrane Risk-of-Bias tool, and observational studies' quality assessment was conducted with Newcastle-Ottawa Scale. Meta-analyses were conducted when appropriate. 20 articles were included comprising 13 RCTs and 6 observational cohort studies in 7 reports and 2019 total participants overall. Among 13 RCTs, 77% involved liver cancer. Methodological study quality scored substantial risk-of-bias across most RCTs. Meta-analysis of RCTs found a 38% decreased risk of post-operative infections in BCAAs group compared to controls (RR = 0.62; 95% CI = 0.44 to 0.87; Branched-chain amino acids during the oncological surgical period demonstrated promise in reducing important post-operative morbidity from infections and ascites compared to controls. Blinded, placebo-controlled confirmatory trials of higher methodological quality are warranted, especially using oral, short-term BCAAs-enriched supplements within the context of recent ERAS programs. CRD42018086168.
Sections du résumé
BACKGROUND
Branched-chain amino acids (BCAAs; leucine, isoleucine, and valine) are essential amino acids involved in immune responses, and may have roles in protein malnutrition and sarcopenia. Furthermore, certain liver diseases have been associated with a decreased Fischer's ratio (BCAAs to aromatic amino acids; phenylalanine, tyrosine, and tryptophan). We aimed to evaluate the safety and efficacy of BCAAs use in patients with cancer undergoing surgery.
METHODS
MEDLINE, Embase, and CENTRAL were searched (inception to July 24, 2020) for randomized controlled trials (RCTs) and comparative observational studies in English evaluating BCAAs (alone or in combinations) during the oncological peri-operative period. Study selection, data extraction, and quality appraisal were done in duplicate. RCT risk-of-bias was appraised using Cochrane Risk-of-Bias tool, and observational studies' quality assessment was conducted with Newcastle-Ottawa Scale. Meta-analyses were conducted when appropriate.
RESULTS
20 articles were included comprising 13 RCTs and 6 observational cohort studies in 7 reports and 2019 total participants overall. Among 13 RCTs, 77% involved liver cancer. Methodological study quality scored substantial risk-of-bias across most RCTs. Meta-analysis of RCTs found a 38% decreased risk of post-operative infections in BCAAs group compared to controls (RR = 0.62; 95% CI = 0.44 to 0.87;
CONCLUSIONS
Branched-chain amino acids during the oncological surgical period demonstrated promise in reducing important post-operative morbidity from infections and ascites compared to controls. Blinded, placebo-controlled confirmatory trials of higher methodological quality are warranted, especially using oral, short-term BCAAs-enriched supplements within the context of recent ERAS programs.
PROSPERO REGISTRATION
CRD42018086168.
Identifiants
pubmed: 33648360
doi: 10.1177/1534735421997551
pmc: PMC7930658
doi:
Substances chimiques
Amino Acids, Branched-Chain
0
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
1534735421997551Références
World J Surg Oncol. 2015 Dec 15;13:336
pubmed: 26666738
World J Surg. 2013 Feb;37(2):285-305
pubmed: 23052796
Nutrition. 2010 May;26(5):482-90
pubmed: 20071143
JPEN J Parenter Enteral Nutr. 2013 May-Jun;37(3):318-26
pubmed: 22898793
Nutrition. 2005 Apr;21(4):480-6
pubmed: 15811769
N Engl J Med. 1994 Dec 8;331(23):1547-52
pubmed: 7969324
Int J Mol Sci. 2018 Mar 23;19(4):
pubmed: 29570613
J Gastroenterol Hepatol. 2015 Sep;30(9):1412-9
pubmed: 25799910
Nutrition. 2012 Nov-Dec;28(11-12):1104-8
pubmed: 23044161
Aust N Z J Surg. 1999 Nov;69(11):811-5
pubmed: 10553972
PLoS One. 2016 Jul 13;11(7):e0159205
pubmed: 27410482
Cochrane Database Syst Rev. 2017 May 18;5:CD001939
pubmed: 28518283
Dig Dis Sci. 2008 Jan;53(1):204-9
pubmed: 17510798
Hepatol Res. 2005 Sep;33(1):27-32
pubmed: 16169275
Lancet. 1979 Oct 13;2(8146):772-5
pubmed: 90864
Biochem Biophys Res Commun. 1995 Sep 25;214(3):1045-50
pubmed: 7575508
Nat Med. 2014 Oct;20(10):1193-1198
pubmed: 25261994
HPB (Oxford). 2013 Nov;15(11):908-15
pubmed: 23461811
Ann Surg Oncol. 2016 Oct;23(11):3727-3735
pubmed: 27338747
Oncotarget. 2015 Oct 13;6(31):31522-43
pubmed: 26372729
Hepatol Res. 2004 Aug;29(4):207-211
pubmed: 15288012
Hepatology. 2009 Dec;50(6):1936-45
pubmed: 19885880
PLoS Med. 2009 Jul 21;6(7):e1000097
pubmed: 19621072
Nutr Cancer. 2014;66(8):1269-78
pubmed: 25298128
Hepatogastroenterology. 2010 May-Jun;57(99-100):583-90
pubmed: 20698232
JPEN J Parenter Enteral Nutr. 2019 Feb;43(2):220-225
pubmed: 30334261
Biochem Biophys Res Commun. 2003 Mar 28;303(1):59-64
pubmed: 12646166
Med Arch. 2014 Aug;68(4):263-7
pubmed: 25568549
J Immunol. 2007 Nov 15;179(10):7137-46
pubmed: 17982106
JPEN J Parenter Enteral Nutr. 1986 Jan-Feb;10(1):17-20
pubmed: 3080621
World J Surg. 2013 Feb;37(2):259-84
pubmed: 23052794
Cochrane Database Syst Rev. 2012 Aug 15;(8):CD007605
pubmed: 22895962
Liver Transpl. 2011 Sep;17(9):1073-80
pubmed: 21542128
Clin Nutr. 2006 Apr;25(2):224-44
pubmed: 16698152
Clin Nutr. 2013 Dec;32(6):879-87
pubmed: 24189391
Surgery. 1976 Jul;80(1):77-91
pubmed: 818729
J Clin Epidemiol. 2016 Jul;75:40-6
pubmed: 27005575
J Nutr. 2005 Jun;135(6 Suppl):1596S-601S
pubmed: 15930476
Nat Clin Pract Gastroenterol Hepatol. 2006 Apr;3(4):202-9
pubmed: 16582962
Mol Biol Rep. 2012 Dec;39(12):10803-10
pubmed: 23053977
World J Gastroenterol. 2013 Nov 21;19(43):7620-9
pubmed: 24282351
Surg Today. 2015 Mar;45(3):271-83
pubmed: 24473669
J Nutr. 2000 Oct;130(10):2413-9
pubmed: 11015466
Lancet. 1976 Oct 23;2(7991):880-2
pubmed: 62115
Hepatol Res. 2007 Dec;37(12):1062-7
pubmed: 17608669
J Nutr. 2005 Jun;135(6 Suppl):1547S-52S
pubmed: 15930467
Amino Acids. 2011 Apr;40(4):1213-20
pubmed: 20852905
Updates Surg. 2020 Sep;72(3):681-691
pubmed: 32410162
J Nutr. 2006 Jan;136(1 Suppl):314S-8S
pubmed: 16365105
Clin Gastroenterol Hepatol. 2012 Feb;10(2):117-25
pubmed: 21893127
Curr Opin Clin Nutr Metab Care. 2018 Jan;21(1):64-70
pubmed: 29211698
J Nutr. 2006 Jan;136(1 Suppl):295S-8S
pubmed: 16365102
Eur J Gastroenterol Hepatol. 2003 Jul;15(7):733-7
pubmed: 12811303
J Hepatol. 1991 Jul;13(1):14-20
pubmed: 1918875
Nutrition. 2017 Sep;41:80-85
pubmed: 28760433
World J Surg. 2016 Oct;40(10):2425-40
pubmed: 27549599
J Gastroenterol Hepatol. 2008 Dec;23(12):1869-73
pubmed: 18717761
Surg Today. 2013 Jul;43(7):720-6
pubmed: 22890582
Br J Surg. 1997 Nov;84(11):1525-31
pubmed: 9393270
PLoS One. 2020 Mar 20;15(3):e0229249
pubmed: 32196520
BMJ. 2011 Oct 18;343:d5928
pubmed: 22008217
Amino Acids. 2010 Mar;38(3):901-7
pubmed: 19399583
Am Surg. 2008 Mar;74(3):237-42
pubmed: 18376691
J Gastroenterol Hepatol. 2000 Aug;15(8):849-59
pubmed: 11022824
Ann Surg Oncol. 2019 Jan;26(1):264-272
pubmed: 30367303
J Gastroenterol. 2015 Dec;50(12):1197-205
pubmed: 25847401
Clin Nutr. 2012 Dec;31(6):817-30
pubmed: 23079762
World J Gastroenterol. 2005 Nov 21;11(43):6792-9
pubmed: 16425386
J Nutr. 2006 Jan;136(1 Suppl):288S-93S
pubmed: 16365100
Biochem Biophys Res Commun. 2007 Jun 22;358(1):176-80
pubmed: 17466941
Exp Mol Med. 2019 Nov 29;51(11):1-11
pubmed: 31784505
Clin Nutr. 2019 Apr;38(2):485-521
pubmed: 30712783
JPEN J Parenter Enteral Nutr. 1984 Nov-Dec;8(6):622-7
pubmed: 6394778