Protein tolerance to standard and high protein meals in patients with liver cirrhosis

Table 1 Amino acid content of the 20 g protein meal

Amino acid	Content (mg)
Isoleucine	934
Leucine	1500
Lysine	1588
Methionine	563
Cysteine	240
Phenylalanine	867
Tyrosine	723
Threonine	872
Tryptophan	255
Arginine	1161
Histidine	637
Alanine	1104
Asparagine	2109
Glutamic acid	3229
Glycine	935
Proline	999
Serine	901

Table 2 Protein content of the 1 g/kg protein meals

Patient	Energy (kcal)	Protein (g)	%kcal
1	914	94	40
2	973	78	32
3	590	56	36
4	653	38	23
5	1545	78	20
6	1507	65	17

Table 3 Plasma amino acid response to a 20-g protein mixed meal in cirrhotic patients and controls

Amino acid	Group	Basal (± SE)	30 min (± SE)	60 min (± SE)	120 min (± SE)	180 min (± SE)	240 min (± SE)
Tau	Control	69 ± 17	65 ± 10	74 ± 10	74 ± 11	69 ± 8
	Cirrhotic	48 ± 5	46 ± 7	42 ± 5a	47 ± 6	44 ± 4	42 ± 7
Thr	Control	101 ± 5	117 ± 10c	110 ± 3	115 ± 8	114 ± 12
	Cirrhotic	113 ± 10	124 ± 8	125 ± 11	118 ± 8	101 ± 8	111 ± 15
Ser	Control	94 ± 8	105 ± 8f	104 ± 9d	99 ± 11	92 ± 13
	Cirrhotic	105 ± 7	117 ± 8c	114 ± 10	108 ± 9	96 ± 7	103 ± 12
Asn	Control	23 ± 2	40 ± 2d	41 ± 4d	40 ± 4d	35 ± 5c
	Cirrhotic	35 ± 3a	43 ± 3f	44 ± 5d	44 ± 4d	37 ± 4	38 ± 5
Glu	Control	246 ± 33	299 ± 35	263 ± 17	276 ± 24	237 ± 26
	Cirrhotic	375 ± 30	388 ± 20	380 ± 34	375 ± 23	354 ± 22	378 ± 45
Gln	Control	163 ± 11	163 ± 14	154 ± 13	142 ± 11	144 ± 26
	Cirrhotic	226 ± 21ª	217 ± 18	213 ± 14ª	213 ± 20	190 ± 12	180 ± 29
Pro	Control	145 ± 11	152 ± 13	151 ± 5	155 ± 12	135 ± 7
	Cirrhotic	152 ± 15	147 ± 17	173 ± 19	185 ± 17c	155 ± 16	150 ± 15
Gly	Control	178 ± 8	187 ± 11	190 ± 14	193 ± 16	176 ± 21
	Cirrhotic	174 ± 14	177 ± 14	166 ± 13	176 ± 11	170 ± 12	165 ± 16
Ala	Control	271 ± 18	323 ± 21d	339 ± 29d	354 ± 31d	309 ± 34
	Cirrhotic	262 ± 17	310 ± 24c	334 ± 34	345 ± 25d	307 ± 26	284 ± 38
Cit
	Cirrhotic	27 ± 3	23 ± 2	20 ± 2	27 ± 2	28 ± 2	33 ± 4
Val	Control	167 ± 13	186 ± 14d	182 ± 16c	188 ± 11d	173 ± 16
	Cirrhotic	180 ± 4	198 ± 10c	203 ± 9c	193 ± 10	170 ± 8	175 ± 18
Cys	Control	42 ± 1	41 ± 2	40 ± 2	42 ± 3	39 ± 4
	Cirrhotic	58 ± 3b	59 ± 2e	60 ± 3e	62 ± 2	58 ± 4b	56 ± 5
Met	Control	25 ± 2	24 ± 1	25 ± 1	29 ± 4	27 ± 4
	Cirrhotic	32 ± 3	30 ± 2a	33 ± 3	31 ± 2	25 ± 3	25 ± 3
Iso	Control	49 ± 3	55 ± 4	54 ± 5	62 ± 5	57 ± 7
	Cirrhotic	55 ± 2	68 ± 3a,d	71 ± 4a,d	59 ± 2	50 ± 3	55 ± 7
Leu	Control	91 ± 6	101 ± 8c	97 ± 10	103 ± 8	95 ± 11
	Cirrhotic	101 ± 2	126 ± 7a,d	128 ± 7a,d	106 ± 5	87 ± 5	95 ± 12
Tyr	Control	53 ± 3	56 ± 2c	55 ± 3	56 ± 4	54 ± 6
	Cirrhotic	73 ± 7a	80 ± 7	83 ± 8b	82 ± 8a	73 ± 6	76 ± 10
Phe	Control	37 ± 0.8	39 ± 1	40 ± 2	42 ± 4	40 ± 5
	Cirrhotic	48 ± 5	58 ± 7	61 ± 9	62 ± 9	57 ± 7	56 ± 7
Orn	Control	41 ± 2	44 ± 2	44 ± 3	47 ± 3	45 ± 5
	Cirrhotic	61 ± 5b	67 ± 4	69 ± 6	71 ± 7d	68 ± 6	71 ± 11
Lys	Control	145 ± 10	169 ± 13d	175 ± 13d	194 ± 13f	169 ± 17c
	Cirrhotic	144 ± 6	167 ± 9c	171 ± 11c	164 ± 11	153 ± 9	150 ± 15
His	Control	64 ± 3	73 ± 3d	72 ± 4c	72 ± 4c	67 ± 8
	Cirrhotic	63 ± 4	70 ± 3	73 ± 4	72 ± 4	69 ± 4	65 ± 5
Arg	Control	70 ± 4	83 ± 5d	85 ± 6c	88 ± 6d	77 ± 8
	Cirrhotic	73 ± 5	81 ± 6	85 ± 7	86 ± 6	80 ± 7	71 ± 8
BCAA/AAA	Control	3.44 ± 0.2	3.62 ± 0.2	3.49 ± 0.2	3.65 ± 0.2	3.54 ± 0.2
	Cirrhotic	2.89 ± 0.2	2.97 ± 0.2	2.92 ± 0.2	2.62 ± 0.2c	2.45 ± 0.2d	2.53 ± 0.2f

Plasma amino acid response to a 20 g protein mixed meal in cirrhotic patients and controls. The results are expressed as means ± SEM. Healthy subjects n = 6, cirrhotics n = 8. Plasma amino acids are given in nmol/mL; significantly different from the corresponding value of control subject:

^aP < 0.05,

^bP < 0.01,

^eP < 0.001; Significantly different from basal value within the same group

^cP < 0.05,

^dP < 0.01,

^fP < 0.001.

Table 4 Plasma amino acid response to a high (1 g protein/kg body weight) meal in cirrhotic patients

Amino acid	Group	Basal (± SE)	30 min (± SE)	60 min (± SE)	120 min (± SE)	180 min (± SE)	240 min (± SE)
Taurine	Cirrhotic	58 ± 1	54 ± 4	59 ± 5	58 ± 3	57 ± 4	54 ± 3
Threonine	Cirrhotic	150 ± 25	152 ± 22	169 ± 23	195 ± 29c	216 ± 43	216 ± 31
Serine	Cirrhotic	114 ± 11	131 ± 17	151 ± 20	153 ± 16f	156 ± 21	158 ± 15
Asparagine	Cirrhotic	46 ± 3	60 ± 5	67 ± 6f	76 ± 3	76 ± 7	73 ± 8
Glutamic ac.	Cirrhotic	110 ± 30	94 ± 25	88 ± 36	109 ± 29	130 ± 26	153 ± 79
Glutamine	Cirrhotic	449 ± 29	462 ± 64	514 ± 56	560 ± 43	578 ± 39	520 ± 82
Proline	Cirrhotic	182 ± 35	212 ± 30	220 ± 26	278 ± 30	266 ± 32	245 ± 34
Glycine	Cirrhotic	199 ± 13	225 ± 20	245 ± 25	272 ± 12d	276 ± 25	273 ± 21
Alanine	Cirrhotic	326 ± 23	408 ± 41	465 ± 48c	462 ± 12	456 ± 29	475 ± 47
Citruline	Cirrhotic	48 ± 7	44 ± 7	48 ± 7	58 ± 5	50 ± 7	59 ± 10
Valine	Cirrhotic	146 ± 23	160 ± 19	185 ± 19	209 ± 29c	224 ± 36	243 ± 29
Cysteine	Cirrhotic	53 ± 3	55 ± 4	61 ± 7	60 ± 4	57 ± 3	63 ± 4d
Methionine	Cirrhotic	34 ± 4	41 ± 4	45 ± 4	54 ± 6f	58 ± 6	64 ± 8
Isoleucine	Cirrhotic	43 ± 2	57 ± 6	63 ± 6d	86 ± 12	97 ± 16	107 ± 11
Leucine	Cirrhotic	73 ± 10	93 ± 12	107 ± 14	135 ± 25c	149 ± 31	160 ± 20
Tyrosine	Cirrhotic	109 ± 13	115 ± 8	123 ± 11	139 ± 8c	144 ± 8	159 ± 15
Phenylalanine	Cirrhotic	58 ± 7	66 ± 5	77 ± 10	84 ± 10f	86 ± 9	98 ± 12
Ornithine	Cirrhotic	62 ± 7	69 ± 6	73 ± 7	81 ± 4f	90 ± 8	94 ± 9
Lysine	Cirrhotic	148 ± 10	179 ± 22	211 ± 27c	240 ± 32	248 ± 40	253 ± 32
Histidine	Cirrhotic	68 ± 8	80 ± 8	89 ± 7	90 ± 8	91 ± 10	93 ± 7
Arginine	Cirrhotic	91 ± 9	99 ± 10	109 ± 14	134 ± 11c	139 ± 18	152 ± 19
BCAA/AAA	Cirrhotic	1.69 ± 0.3	1.74 ± 0.2	1.81 ± 0.2	1.93 ± 0.3	2.03 ± 0.3c	2.08 ± 0.4c

The results are expressed as means ± SEM. Plasma amino acids are given in nmol/mL. First value significantly different from basal value:

^cP < 0.05,

^dP < 0.01,

^fP < 0.02.