In hepatic encephalopathy, which balance do BCAA enriched formulas aim to correct?

• A. Increase aromatic amino acids to branched-chain amino acids ratio
• B. Decrease aromatic amino acids and increase branched-chain amino acids ratio
• C. No effect on amino acids balance
• D. Increase both aromatic and branched-chain amino acids equally

Answer: (B)

Balancing amino acids in hepatic encephalopathy centers on the ratio of aromatic amino acids to branched-chain amino acids. In HE, aromatic amino acids tend to be elevated while branched-chain amino acids are reduced, shifting the balance in a way that can worsen brain dysfunction. BCAA-enriched formulas aim to correct this by decreasing the relative amount of aromatic amino acids and increasing the branched-chain amino acid pool. They supply extra BCAAs and, by competing for transport across the blood-brain barrier, help reduce the brain uptake of aromatic amino acids, lowering neurotoxic influences and improving symptoms. So the goal is to lower aromatic amino acids and raise the BCAA ratio.