Comparison of the Effects of Hepatic-Aid and a Casein Modular Diet on Enceph-alopathy, Plasma Amino Acids, and Nitrogen Balance in Cirrhotic Patients

Hepatic-Aid is purported to ameliorate encephalopathy and promote positive nitrogen balance in protein-intolerant, cirrhotic patients by correcting their imbalanced amino acid profile. This study evaluated Hepatic-Aid by comparing a 50-g Casein diet with an identical diet with 20-g Casein/30-g Hepatic-Aid per day in a cross-over study. Four patients with biopsy-proven stable cirrhosis, encephalopathy, and under-nutrition were studied. Each study period included three days of equilibration and eight days of metabolic balance, with the following measured at baseline and on balance days 5 and 8: routine biochemistry, fasting ammonia, psychometric tests, EEG, and plasma amino acid profiles. There was no significant change in clinical status, routine biochemistry, fasting ammonia, psychometrics or EEG between the two study periods. Mean (±SD) nitrogen balance on the Casein diet at 1.5 ± 1.5 g/day was not significantly different from that on the Hepatic-Aid diet at 1.5 ± 1.2 g/day. Plasma amino acid profiles showed a significant fall (p < 0.05) in fasting and intraprandial tyrosine (tyr) and phenylalanine (phe) on Hepatic-Aid, but only intraprandial leucine (leu), isoleucine (ile), and valine (val) were significantly increased (p < 0.05) on Hepatic-Aid. The ratio leu + ile + val to tyr + phe was significantly increased (p < 0.05) on Hepatic-Aid. It is concluded that Hepatic-Aid, as given in this study, maintains N balance similar to Casein, alters the amino acid profile towards normal, but does not ameliorate encephalopathy.