Korean J Gastroenterol.  2023 Nov;82(5):233-238. 10.4166/kjg.2023.127.

Sarcopenia in Chronic Liver Disease

• Seo KI

• KMID: 2548493
• DOI: http://doi.org/10.4166/kjg.2023.127

Abstract

Sarcopenia is a crucial factor in assessing the nutritional status of chronic liver disease patients and predicting their prognosis and survival. The serum ammonia level is closely associated with sarcopenia regarding ammonia, a key regulator in the liver-muscle axis. In addition, various changes in energy metabolism and hormones are also involved in sarcopenia. The psoas muscle area can represent the overall skeletal muscle mass in liver disease patients. Therefore, measuring the psoas muscle area with computed tomography or magnetic resonance imaging is considered an objective and reliable method for assessing muscle mass. Providing sufficient calorie and protein intake is crucial for preventing and treating sarcopenia. In addition, engaging in appropriate exercise and addressing concurrent hormonal and metabolic changes can be helpful.

Keyword

Sarcopenia; Ammonia; Psoas muscle; Nutrition status

Reference

1. Lai JC, Tandon P, Bernal W, et al. 2021; Malnutrition, frailty, and sarcopenia in patients with cirrhosis: 2021 Practice guidance by the American association for the study of liver diseases. Hepatology. 74:1611–1644. DOI: 10.1002/hep.32049. PMID: 34233031. PMCID: PMC9134787.

2. D'Amico G, Garcia-Tsao G, Pagliaro L. 2006; Natural history and prognostic indicators of survival in cirrhosis: a systematic review of 118 studies. J Hepatol. 44:217–231. DOI: 10.1016/j.jhep.2005.10.013. PMID: 16298014.

3. Kamath PS, Mookerjee RP. 2015; Individualized care for portal hypertension: Not quite yet. J Hepatol. 63:543–545. DOI: 10.1016/j.jhep.2015.07.001. PMID: 26150255.

4. European Association for the Study of the Liver. 2019; EASL Clinical Practice Guidelines on nutrition in chronic liver disease. J Hepatol. 70:172–193. DOI: 10.1016/j.jhep.2018.06.024. PMID: 30144956. PMCID: PMC6657019.

5. Nutritional status in cirrhosis. 1994; Italian Multicentre cooperative project on nutrition in liver cirrhosis. J Hepatol. 21:317–325. DOI: 10.1016/S0168-8278(05)80308-3. PMID: 7836699.

6. Tandon P, Raman M, Mourtzakis M, Merli M. 2017; A practical approach to nutritional screening and assessment in cirrhosis. Hepatology. 65:1044–1057. DOI: 10.1002/hep.29003. PMID: 28027577.

7. Tantai X, Liu Y, Yeo YH, et al. 2022; Effect of sarcopenia on survival in patients with cirrhosis: A meta-analysis. J Hepatol. 76:588–599. DOI: 10.1016/j.jhep.2021.11.006. PMID: 34785325.

8. Tandon P, Ney M, Irwin I, et al. 2012; Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value. Liver Transpl. 18:1209–1216. DOI: 10.1002/lt.23495. PMID: 22740290.

9. Tandon P, Ney M, Irwin I, et al. 2012; Severe muscle depletion in patients on the liver transplant wait list: its prevalence and independent prognostic value. Liver Transpl. 18:1209–1216. DOI: 10.1002/lt.23495. PMID: 22740290.

10. Praktiknjo M, Book M, Luetkens J, et al. 2018; Fat-free muscle mass in magnetic resonance imaging predicts acute-on-chronic liver failure and survival in decompensated cirrhosis. Hepatology. 67:1014–1026. DOI: 10.1002/hep.29602. PMID: 29059469.

11. Koo BK, Kim D, Joo SK, et al. 2017; Sarcopenia is an independent risk factor for non-alcoholic steatohepatitis and significant fibrosis. J Hepatol. 66:123–131. DOI: 10.1016/j.jhep.2016.08.019. PMID: 27599824.

12. Hiraoka A, Hirooka M, Koizumi Y, et al. 2017; Muscle volume loss as a prognostic marker in hepatocellular carcinoma patients treated with sorafenib. Hepatol Res. 47:558–565. DOI: 10.1111/hepr.12780. PMID: 27480045.

13. Traub J, Reiss L, Aliwa B, Stadlbauer V. 2021; Malnutrition in patients with liver cirrhosis. Nutrients. 13:540. DOI: 10.3390/nu13020540. PMID: 33562292. PMCID: PMC7915767.

14. Peng S, Plank LD, McCall JL, Gillanders LK, McIlroy K, Gane EJ. 2007; Body composition, muscle function, and energy expenditure in patients with liver cirrhosis: a comprehensive study. Am J Clin Nutr. 85:1257–1266. DOI: 10.1093/ajcn/85.5.1257. PMID: 17490961.

15. Braillon A, Cales P, Valla D, Gaudy D, Geoffroy P, Lebrec D. 1986; Influence of the degree of liver failure on systemic and splanchnic haemodynamics and on response to propranolol in patients with cirrhosis. Gut. 27:1204–1209. DOI: 10.1136/gut.27.10.1204. PMID: 3781335. PMCID: PMC1433865.

16. Dolz C, Raurich JM, Ibáñez J, Obrador A, Marsé P, Gayá J. 1991; Ascites increases the resting energy expenditure in liver cirrhosis. Gastroenterology. 100:738–744. DOI: 10.1016/0016-5085(91)80019-6. PMID: 1993495.

17. Tsiaousi ET, Hatzitolios AI, Trygonis SK, Savopoulos CG. 2008; Malnutrition in end stage liver disease: recommendations and nutritional support. J Gastroenterol Hepatol. 23:527–533. DOI: 10.1111/j.1440-1746.2008.05369.x. PMID: 18397483.

18. Cabré E, Hernández-Pérez JM, Fluvià L, Pastor C, Corominas A, Gassull MA. 2005; Absorption and transport of dietary long-chain fatty acids in cirrhosis: a stable-isotope-tracing study. Am J Clin Nutr. 81:692–701. DOI: 10.1093/ajcn/81.3.692. PMID: 15755841.

19. Cheung K, Lee SS, Raman M. 2012; Prevalence and mechanisms of malnutrition in patients with advanced liver disease, and nutrition management strategies. Clin Gastroenterol Hepatol. 10:117–125. DOI: 10.1016/j.cgh.2011.08.016. PMID: 21893127.

20. Kalaitzakis E, Bosaeus I, Ohman L, Björnsson E. 2007; Altered postprandial glucose, insulin, leptin, and ghrelin in liver cirrhosis: correlations with energy intake and resting energy expenditure. Am J Clin Nutr. 85:808–815. DOI: 10.1093/ajcn/85.3.808. PMID: 17344504.

21. Olde Damink SW, Jalan R, Dejong CH. 2009; Interorgan ammonia trafficking in liver disease. Metab Brain Dis. 24:169–181. DOI: 10.1007/s11011-008-9122-5. PMID: 19067143.

22. Dasarathy S, Hatzoglou M. 2018; Hyperammonemia and proteostasis in cirrhosis. Curr Opin Clin Nutr Metab Care. 21:30–36. DOI: 10.1097/MCO.0000000000000426. PMID: 29035972. PMCID: PMC5806198.

23. Dasarathy S, Merli M. 2016; Sarcopenia from mechanism to diagnosis and treatment in liver disease. J Hepatol. 65:1232–1244. DOI: 10.1016/j.jhep.2016.07.040. PMID: 27515775. PMCID: PMC5116259.

24. Dasarathy S. 2017; Myostatin and beyond in cirrhosis: all roads lead to sarcopenia. J Cachexia Sarcopenia Muscle. 8:864–869. DOI: 10.1002/jcsm.12262. PMID: 29168629. PMCID: PMC5700432.

25. Van Thiel DH, Kumar S, Gavaler JS, Tarter RE. 1990; Effect of liver transplantation on the hypothalamic-pituitary-gonadal axis of chronic alcoholic men with advanced liver disease. Alcohol Clin Exp Res. 14:478–481. DOI: 10.1111/j.1530-0277.1990.tb00507.x. PMID: 2116098.

26. Kaufman JM, Vermeulen A. 2005; The decline of androgen levels in elderly men and its clinical and therapeutic implications. Endocr Rev. 26:833–876. DOI: 10.1210/er.2004-0013. PMID: 15901667.

27. Kachaamy T, Bajaj JS. 2011; Diet and cognition in chronic liver disease. Curr Opin Gastroenterol. 27:174–179. DOI: 10.1097/MOG.0b013e3283409c25. PMID: 20975555.

28. Yao J, Chang L, Yuan L, Duan Z. 2016; Nutrition status and small intestinal bacterial overgrowth in patients with virus-related cirrhosis. Asia Pac J Clin Nutr. 25:283–291.

29. Morgan MY, Madden AM, Soulsby CT, Morris RW. 2006; Derivation and validation of a new global method for assessing nutritional status in patients with cirrhosis. Hepatology. 44:823–835. DOI: 10.1002/hep.21358. PMID: 17006918.

30. Williams FR, Milliken D, Lai JC, Armstrong MJ. 2021; Assessment of the frail patient with end-stage liver disease: A practical overview of sarcopenia, physical function, and disability. Hepatol Commun. 5:923–937. DOI: 10.1002/hep4.1688. PMID: 34141980. PMCID: PMC8183168.

31. Benjamin J, Shasthry V, Kaal CR, et al. 2017; Characterization of body composition and definition of sarcopenia in patients with alcoholic cirrhosis: A computed tomography based study. Liver Int. 37:1668–1674. DOI: 10.1111/liv.13509. PMID: 29065258.

32. Shen W, Punyanitya M, Wang Z, et al. 2004; Total body skeletal muscle and adipose tissue volumes: estimation from a single abdominal cross-sectional image. J Appl Physiol (1985). 97:2333–2338. DOI: 10.1152/japplphysiol.00744.2004. PMID: 15310748.

33. Gu DH, Kim MY, Seo YS, et al. 2018; Clinical usefulness of psoas muscle thickness for the diagnosis of sarcopenia in patients with liver cirrhosis. Clin Mol Hepatol. 24:319–330. DOI: 10.3350/cmh.2017.0077. PMID: 29706058. PMCID: PMC6166111.

34. Bischoff SC, Barazzoni R, Busetto L, et al. 2022; European guideline on obesity care in patients with gastrointestinal and liver diseases- Joint ESPEN/UEG guideline. Clin Nutr. 41:2364–2405. DOI: 10.1016/j.clnu.2022.07.003. PMID: 35970666.

35. Shaw J, Tate V, Hanson J, Bajaj JS. 2020; What diet should I recommend my patient with Hepatic Encephalopathy? Curr Hepatol Rep. 19:13–22. DOI: 10.1007/s11901-020-00510-4. PMID: 33457180. PMCID: PMC7810167.

36. Sorrentino P, Castaldo G, Tarantino L, et al. 2012; Preservation of nutritional-status in patients with refractory ascites due to hepatic cirrhosis who are undergoing repeated paracentesis. J Gastroenterol Hepatol. 27:813–822. DOI: 10.1111/j.1440-1746.2011.07043.x. PMID: 22142548.

37. Plank LD, Gane EJ, Peng S, et al. 2008; Nocturnal nutritional supplementation improves total body protein status of patients with liver cirrhosis: a randomized 12-month trial. Hepatology. 48:557–566. DOI: 10.1002/hep.22367. PMID: 18627001.

38. García-Pagàn JC, Santos C, Barberá JA, et al. 1996; Physical exercise increases portal pressure in patients with cirrhosis and portal hypertension. Gastroenterology. 111:1300–1306. DOI: 10.1053/gast.1996.v111.pm8898644. PMID: 8898644.

39. Berzigotti A, Albillos A, Villanueva C, et al. 2017; Effects of an intensive lifestyle intervention program on portal hypertension in patients with cirrhosis and obesity: The SportDiet study. Hepatology. 65:1293–1305. DOI: 10.1002/hep.28992. PMID: 27997989.

40. Kumar A, Davuluri G, Silva RNE, et al. 2017; Ammonia lowering reverses sarcopenia of cirrhosis by restoring skeletal muscle proteostasis. Hepatology. 65:2045–2058. DOI: 10.1002/hep.29107. PMID: 28195332. PMCID: PMC5444955.

41. Kitajima Y, Takahashi H, Akiyama T, et al. 2018; Supplementation with branched-chain amino acids ameliorates hypoalbuminemia, prevents sarcopenia, and reduces fat accumulation in the skeletal muscles of patients with liver cirrhosis. J Gastroenterol. 53:427–437. DOI: 10.1007/s00535-017-1370-x. PMID: 28741271.

42. Park JG, Tak WY, Park SY, et al. 2017; Effects of branched-chain amino acids (BCAAs) on the progression of advanced liver disease: A Korean nationwide, multicenter, retrospective, observational, cohort study. Medicine (Baltimore). 96:e6580. DOI: 10.1097/MD.0000000000006580. PMID: 28614215. PMCID: PMC5478300.

43. Sinclair M, Grossmann M, Hoermann R, Angus PW, Gow PJ. 2016; Testosterone therapy increases muscle mass in men with cirrhosis and low testosterone: A randomised controlled trial. J Hepatol. 65:906–913. DOI: 10.1016/j.jhep.2016.06.007. PMID: 27312945.