{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T16:26:20Z","timestamp":1792167980259,"version":"4.4.0"},"reference-count":81,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Integr Cancer Ther"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>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\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>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\u2019 quality assessment was conducted with Newcastle-Ottawa Scale. Meta-analyses were conducted when appropriate.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      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\u2009=\u20090.62; 95% CI\u2009=\u20090.44 to 0.87; P\u2009=\u2009.006; number of RCTs, k\u2009=\u20096; total sample size, N\u2009=\u2009389; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%). BCAAs were also found to be beneficial for ascites (RR\u2009=\u20090.55; 95% CI\u2009=\u20090.35 to 0.86; P\u2009=\u2009.008; k\u2009=\u20094; N\u2009=\u2009296; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090%), body weight (MD\u2009=\u20093.24\u2009kg; 95% CI\u2009=\u20090.44 to 6.04; P\u2009=\u2009.02; k\u2009=\u20093; N\u2009=\u2009196; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200924%), and hospitalization length (MD\u2009=\u2009\u22122.07\u2009days; 95% CI\u2009=\u2009\u22123.97 to \u22120.17; P\u2009=\u2009.03; k\u2009=\u20095; N\u2009=\u2009362; I\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u200959%). No differences were found between BCAAs and controls for mortality, recurrence, other post-operative complications (liver failure, edema, pleural effusion), blood loss, quality of life, ammonia level, and prothrombin time. No serious adverse events were related to BCAAs; however, serious adverse events were reported due to intravenous catheters. No safety concerns from observational studies were identified.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration:<\/jats:title>\n                    <jats:p>CRD42018086168.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/1534735421997551","type":"journal-article","created":{"date-parts":[[2021,3,2]],"date-time":"2021-03-02T01:48:32Z","timestamp":1614649712000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":18,"title":["Are Supplemental Branched-Chain Amino Acids Beneficial During the Oncological Peri-Operative Period: A Systematic Review and 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