Substitution of One Meat-Based Meal With Vegetarian and Vegan Alternatives Generates Lower Ammonia and Alters Metabolites in Cirrhosis: A Randomized Clinical Trial

作者：Bryan D. Badal, Andrew Fagan, Victoria V. Tate, Travis Mousel, Mary Leslie Gallagher, Puneet Puri, Brian Davis, Jennifer Miller, Masoumeh Sikaroodi, Patrick Martin Gillevet, Rolandas Gedgaudas, Juozas Kupcinskas, Leroy R. Thacker, Jasmohan Singh Bajaj · 发表于：Clinical and Translational Gastroenterology · 年份：2024 · DOI：10.14309/ctg.0000000000000707 · 被引用次数：12 · 研究领域：Liver Disease and Transplantation、Liver Disease Diagnosis and Treatment、Organ Transplantation Techniques and Outcomes

INTRODUCTION: Diet can affect ammoniagenesis in cirrhosis and hepatic encephalopathy (HE), but the impact of dietary preferences on metabolomics in cirrhosis is unclear. As most Western populations follow meat-based diets, we aimed to determine the impact of substituting a single meat-based meal with an equal protein-containing vegan/vegetarian alternative on ammonia and metabolomics in outpatients with cirrhosis on a meat-based diet. METHODS: Outpatients with cirrhosis with and without prior HE on a stable Western meat-based diet were randomized 1:1:1 into 3 groups. Patients were given a burger with 20 g protein of meat, vegan, or vegetarian. Blood for metabolomics via liquid chromatography-mass spectrometry and ammonia was drawn at baseline and hourly for 3 hours after meal while patients under observation. Stool microbiome characteristics, changes in ammonia, and metabolomics were compared between/within groups. RESULTS: Stool microbiome composition was similar at baseline. Serum ammonia increased from baseline in the meat group but not the vegetarian or vegan group. Metabolites of branched chain and acylcarnitines decreased in the meat group compared with the non-meat groups. Alterations in lipid profile (higher sphingomyelins and lower lysophospholipids) were noted in the meat group when compared with the vegan and vegetarian groups. DISCUSSION: Substitution of a single meat-based meal with a non-meat alternatives results in lower ammoniagenesis and altered serum metabol...