Comparing The Effects Of Whey And Casein Supplementation On Nutritional Status And Immune Parameters In Patients With Chronic Liver Disease: A Randomised Double-Blind Controlled Trial

Protein supplementation may be beneficial for patients with chronic liver disease (CLD). This study compared the effects of whey protein isolate (WP) and casein (CA) supplementation on nutritional status and immune parameters of CLD patients who were randomly assigned to take 20 g of WP or CA twice per d as a supplement for 15 d. Body composition, muscle functionality and plasmatic immunomarkers were assessed before and after supplementation. Patients were also classified according to the model for end-stage liver disease (MELD) into less (MELD < 15) and more (MELD >= 15) severe disease groups. Malnutrition, determined by the Subjective Global Assessment at baseline, was observed in 57 center dot 4 % and 54 center dot 2 % of patients in the WP and CA groups, respectively (P = 0 center dot 649). Protein intake was lower at baseline in the WP group than in the CA group (P = 0 center dot 035), with no difference after supplementation (P = 0 center dot 410). Both the WP and CA MELD < 15 groups increased protein intake after supplementation according to the intragroup analysis. No differences were observed in body composition, muscle functionality, most plasma cytokines (TNF, IL-6, IL-1 beta and interferon-gamma), immunomodulatory proteins (sTNFR1, sTNFR2, brain-derived neurotrophic factor and glial cell line-derived neurotrophic factor) or immunomodulatory hormones (adiponectin, insulin and leptin) after supplementation in the WP groups at the two assessed moments. WP supplementation increased the levels of interferon-gamma-induced protein-10/CXCL10 (P = 0 center dot 022), eotaxin-1/CCL11 (P = 0 center dot 031) and monocyte chemoattractant protein-1/CCL2 (P = 0 center dot 018) and decreased IL-5 (P = 0 center dot 027), including among those in the MELD >= 15 group, for whom IL-10 was also increased (P = 0 center dot 008). Thus, WP consumption by patients with CLD impacted the immunomodulatory responses when compared with CA with no impact on nutritional status.