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Summary: Background: Sarcopenia is associated with adverse outcomes in cirrhosis. Branched‐chain amino acids (BCAA) target several pathways that lead to muscle loss in this population. Aims: We aimed to evaluate the impact of BCAA supplementation on sarcopenia measures in patients with cirrhosis. Methods: We conducted a 12‐month double‐blinded, randomised, controlled trial of BCAA supplementation (30 g daily) compared to an equicaloric, equi‐nitrogenous whey protein in volunteers with cirrhosis and reduced muscle strength. The primary endpoint was an increase in grip strength and upper limb lean mass measured on DEXA. Mean‐adjusted differences (MAD, 95% CI) between groups at 6 and 12 months are reported as treatment effect using a linear mixed model for repeated measures. Results: A total of 150 volunteers entered the trial (74 BCAA, 76 control), with a median age of 58 years [IQR 48; 63] and MELD of 14 [12; 17]. At 12 months, 57% in the BCAA arm and 61% in the control arm met the primary endpoint (p = 0.80). No significant between‐group difference was found in grip strength (MAD ‐0.15 kg [−0.37; 0.06], p = 0.29) or upper limb lean mass (1.7 kg [−0.2; 3.6], p = 0.22) at 12 months. No significant differences in other body composition parameters, physical performance, frailty, rates of hospitalisation or mortality were found between the BCAA and the control group. Fatigue improved across the entire cohort, without significant between‐group differences. 15% of volunteers reported side effects, with distaste higher in the BCAA arm (p = 0.045). Conclusion: BCAA supplementation did not improve measures of muscle strength, mass or performance or physical frailty compared to a whey protein supplement in a randomised controlled setting. ACTRN12618000802202. [ABSTRACT FROM AUTHOR]

Objective: Aromatase inhibitor (AI) therapy provides oncological benefits in postmenopausal women with oestrogen receptor‐positive breast cancer. However, AI treatment has been associated with increased cardiovascular risk. In nonbreast cancer populations, experimentally induced low oestrogen states and natural transition to menopause have been associated with increases in visceral adipose tissue (VAT), a known surrogate marker for cardiometabolic risk. Given that AI treatment blocks oestradiol production, we hypothesized that AI treatment would increase VAT. Methods: We conducted a prospective 12‐month cohort study of 52 postmenopausal women newly initiating AI treatment (median age: 64.5 years) and 52 women with breast pathology not requiring endocrine therapy (median age: 63.5 years). VAT area and other body composition parameters were measured at baseline, 6 months and 12 months using dual X‐ray absorptiometry. Other risk markers of cardiometabolic health were also assessed. Results: In women initiating AI treatment, there was no statistically significant difference in VAT area after 12 months when compared to controls, with a mean adjusted difference of −5.00 cm2 (−16.9, 6.91), p =.55. Moreover, changes in total fat mass, lean mass, subcutaneous adipose tissue area, hepatic steatosis and measures in endothelial function were also not statistically different between groups after 12 months. Findings were similar after adjustments for activity levels and coronavirus disease 2019 lockdown duration. Conclusions: These data provide reassurance that over the initial 12 months of AI therapy, AI treatment is not associated with metabolically adverse changes in body composition, hepatic steatosis or vascular reactivity. The impact of extended AI therapy on cardiometabolic health requires further study. [ABSTRACT FROM AUTHOR]

This document is a letter to the editor of the journal Thyroid, discussing the clinical and laboratory status of measuring thyrotropin (TSH) and thyroid hormone concentrations. The authors argue that there is no robust empirical evidence to support the longstanding recommendation that TSH concentration is the best blood test for assessing thyroid status. They suggest that thyroid hormone concentrations, particularly free thyroxine (fT4), may be superior to TSH concentrations in terms of correlation with clinical outcomes. The authors also question the theoretical basis for the superiority of TSH concentrations and propose that recommendations regarding the assessment of thyroid status be updated based on recent evidence. [Extracted from the article]