Replacing meat with plant, dairy protein curbs ammonia generation in cirrhosis
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Key takeaways:
- Removing meat from a single meal offers “beneficial metabolomic consequences” in patients with cirrhosis.
- Replacing meat with plant or dairy protein may reduce ammonia generation in these patients.
VANCOUVER, British Columbia — Substituting just one meat-based meal with protein from plant or dairy sources could improve metabolite signatures linked to hepatic encephalopathy in patients with cirrhosis, according to a presenter here.
“The effect of protein intake on ammonia generation in cirrhosis is well-known, as is the impact of vegetarian vs. meat-related diets,” Jasmohan Bajaj, MD, MS, FACG, from the division of gastroenterology, hepatology and nutrition at Virginia Commonwealth University, told Healio. “However, it is unclear whether substituting meat to nonmeat alternatives could reduce ammonia generation, since this is a much more achievable solution for those who eat meat regularly.”
To investigate the effect of meat, vegan and vegetarian meals on ammonia generation in patients with cirrhosis, Bajaj and colleagues randomized 30 men previously on a stable Western meat-based diet to receive one of three equicaloric 20-gram protein burgers: bean (vegetarian), meat substitute (vegan) or pork/beef patty.
The researchers collected blood and ammonia samples at baseline, repeating at hourly intervals for 3 hours following the meal. They also compared baseline stool microbiome characteristics, ammonia and metabolite levels among the three groups.
According to study results, ammonia levels increased above baseline for patients who consumed the meat-based meal, but not for those assigned vegan or vegetarian meals. The researchers also reported significant differences in more than 3,000 metabolites between the groups, including 106 metabolites between meat and vegan groups, 71 metabolites between meat and vegetarian groups and 45 between vegan and vegetarian groups.
“The main take-home message is that removing meat even from a single meal can have major beneficial metabolomic consequences for patients with cirrhosis,” Bajaj told Healio. “Therefore, changing the diet or substituting some parts of it could be a simple and accessible method to reduce ammonia generation.”
In addition, patients who consumed the meat-based meal exhibited higher phospholipid/ceramide, methionine and 5-hydroxylysine levels than patients in the vegan group. Patients in the meat-based group also had higher long-chain fatty acid, sphingolipid, acylcarnitine metabolites and phosphatidylcholine levels than the vegetarian group, yet lower lysophosphatidylcholine than either the vegan or vegetarian groups.
Bajaj and colleagues also noted that patients in the vegan group demonstrated higher N-acyl amino acid levels than those in the meat or vegetarian groups.
“Nutrition is an important tool in management of cirrhosis,” Bajaj said. “Consider involving a dietitian or colleagues who can discuss the dietary preferences of your patient in detail. The impact of the change in even one meal can be profound and therefore, encouraging meat substitution without protein restriction could help patients.”
He added: “Even though these are preliminary [findings], we could counsel those who regularly eat meat to try and substitute meat with sources of protein from plant or dairy sources. However, we need to emphasize that we are not promoting protein restriction, because patients with cirrhosis need protein.”
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Badal BD, et al. Plant-based meals generate lower ammonia and have a unique metabolomic signature compared to meat-based meals despite similar baseline microbiome in patients with cirrhosis. Presented at: ACG Annual Scientific Meeting; Oct. 20-25, 2023; Vancouver, British Columbia (hybrid meeting).
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