AMIN-HEPA INSTANT DRINK Nutrition in Liver Disorders

AMIN-HEPAINSTANT DRINKNutrition in Liver Disorders • HE Etiology • HE Pathologenesis • Treatments of HE • Nutritional Dilemma • Unique Amino Acid formulation • Clinic Evidence 龐振宜藥師

Hepatic Encephalopathy • Neuropsychiatric syndrome • Multifactorial etiology • Secondary to hepatic failure • Synonyms • Portal-systemic encephalopathy • Hepatic coma J.Y. Pang

Stage of Hepatic Encephalopathy Modified Parsons-Smith Rating Scale J. Y. Pang

Pathogenesis of Hepatic Encephalopathy Theories • Amino acid imbalances • BCAA/AAA False neurotransmitters • Methionine • Tryptophan • Ammonia • Unified theory - BCAA/AAA + NH3 • Mercaptans • Short Chain Fatty Acids (SCFA) • Increased cerebral sensitivity J. Y. Pang

Amino acid imbalancesTheory Blood Brain Barrier Brain Liver AAA MET NH3 BCAA Protein intake Muscle James, et al; Lancet, 1979 J. Y. Pang

Abnormal plasma amino acids:chronic liver disease 400 Glu 350 Phe Asp Meth 300 250 Tyr % of Normal 200 Try 150 Gly 100 Orn Thr Ser Lys Tau His Val 50 Leu Arg Pro Ala Ileu Essential Non-Essential Cerra, et al; JPEN, 1985 J. Y. Pang

Protein Intolerance/Hepatic Encephalopathy Cycle Hepatic Encephalopathy Liver Failure Protein Intolerance Malnutrition Catabolism Protein Restriction J. Y. Pang

Reasons for malnutrition • Outpatient • Anorexia, nausea, vomiting • Poor diet • Malabsorption • Hypermetabolism/hypercatabolic state • Inpatient • Abnormal metabolic state, anorexia, malabsorption • Unpalatable diet (low Na, low protein) • Fasting for tests • G-I bleeding, PSE J. Y. Pang

肝臟疾病氨基酸配方TalAmine Hepa 8% inj. • 高枝鏈氨基酸 High BCAA (36%) • 低芳香環氨基酸 Low Aromatics • BCAA:AAA = 37:1 • Low Methionine • Iso:Leu:Val ratio =1:1:1 • 完整蛋白質配製 (for liver disease) • 48小時改善肝昏迷 • 療效優於傳統治療 • 改善體內氨基酸不平衡 • 良好正氮平衡龐振宜

Hepatic Amino Acids SupplementAMIN-HEPA • Leucine • Increase protein synthesis • Decrease protein breakdown • BCAA • Energy source • Regulation amino acids • Hepatic protein synthesis • Metabolism of ammonia • Decrease plasma AAA • Decrease proteolysis • Competition of BCAA with AAA for BBB • increase norepinephrine synthesis J. Y. Pang

Hepatic Amino Acids Supplement AMIN-HEPA • BCAA (42%) • AAA • MET • BCAA/AAA ratio ( 15:1) J. Y. Pang

Hepatic Amino Acids Supplement AMIN-HEPA Per Serving % Calories Serving Size 55g Calories 250 Kcal Carbohydrate 35g 56 Fat 8g 28 Protein 10g 16 Lactalbumin Hydrolysate 7.25g L-leucine 1.10g L-isoleucine 0.88g L-Valine 0.77g

Hepatic Amino Acids Supplement AMIN-HEPA ** No US RDA as been established J. Y. Pang

Hepatic Amino Acids SupplementMulticenter Study • Inclusion Criteria • Stable hepatic disease • Protein intolerant (20-40 Gm/day) • Exclusion Criteria • > Grade 1 encephalopathy • Acute illness Horst, et. al; Hepatology, 1984. J. Y. Pang

Tolerance to Hepatic AA Supplementvs.. Dietary Protein 88% 10% Percent of Patients Developing Encephalopathy J. Y. Pang Horst, et. al; Hepatology, 1984

Increased the blood Fischer's ratio compared to the hepatopathy diet alone (on a molar basis) 2.0 p<0.01 Group first receiving the control treatment Fischer's ratio 1.0 Group first receiving Hepatic AA Suppl. 0.5 Control period 0 Before treatment Week 4 Week 1 Week 2 Week 3 Period of the Hepatic AA Suppl. Hayashi, S., et al: JJPEN 9(3):425-435, 1987 J.Y. Pang

Time course of blood ammonia level (%) 150 Group first receiving Hepatic AA Suppl. 100 Percentage relative to the pretreatment value Group first receiving the control treatment 50 Control period 0 Week 1 Week 2 Week 3 Week 4 Before treatment Period of the Hepatic AA Suppl. Hayashi, S., et al: JJPEN 9(3):425-435, 1987 J.Y. Pang

Improved the impaired nitrogen balance in a severe hepatopathy model (mg N) Aminals that underwent hepatic resection Nitrogen balance value day 1 Day 2 Day 3 Group treatd with marketed preparation for enteral nutrition Group treated with Hepatic AA Suppl. Ohashi, H.,et al:The Clinical Reports, 21(6):2533-2541,1987

AMIN - HEPA INSTANTA nutritionally complete diet for liver disease Log rank test p<0.05 Wilcoxon rank test p<0.05 Gehan-Wilcoxon test p<0.05 Hepatic AA Suppl. (n=31) 纍積生存率 Historical Data (n=31) (月) 16th Asia Pacific Hepatologic Congress Feb. 1988 J. Y. Pang

AMIN - HEPA INSTANTA nutritionally complete diet for liver disease 配製口服 210ml water with one pack of Amin-Hepa 管餵 4 packs of Amin-Hepa into 840ml water as 1 liter solution 用量完全以Amin-Hepa 為營養來源, 每日6-8 包治療劑量每日4包 J. Y. Pang

AMIN - HEPA INSTANTA nutritionally complete diet for liver disease • INDICATION • Hepatic encephalopathy / protein intolerance • Malnourished liver disease patients • Cirrhosis • Hepatitis • Liver transplant J. Y. Pang

AMIN - HEPA INSTANTA nutritionally complete diet for liver disease • Well tolerated enteral supplement for protein intolerant patients • Reduces risk of protein - induced hepatic encephalopathy • Promotes positive nitrogen balance • Improves abnormal plasma amino acid pattern • Does not elevate blood ammonia levels J. Y. Pang

AMIN - HEPA INSTANTA nutritionally complete diet for liver disease BENETITS • Significantly lessens risk of protein-induced HE • Promotes positive nitrogen balance • Modified AA pattern is better tolerated than dietary protein • Flexibility as oral drink or tube feeding can improve patient compliance J. Y. Pang

AMIN-HEPA INSTANT DRINK Nutrition in Liver Disorders