Review article: sarcopenia in cirrhosis – aetiology, implications and potential therapeutic interventions

M. Sinclair; P. J. Gow; M. Grossmann; P. W. Angus

doi:10.1111/apt.13549

journal article Feb 05, 2016

Review article: sarcopenia in cirrhosis – aetiology, implications and potential therapeutic interventions

M. Sinclair P. J. Gow M. Grossmann P. W. Angus

Alimentary Pharmacology & Therapeutics Vol. 43 No. 7 pp. 765-777 · Wiley

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Abstract

SummaryBackgroundSarcopenia (loss of muscle mass) is common in cirrhosis and is associated with poor outcomes. Current teaching recommends the use of protein supplementation and exercise, however, this fails to address many other factors which contribute to muscle loss in this setting.AimsTo summarise existing knowledge regarding the aetiology of sarcopenia in cirrhosis, diagnostic modalities and the clinical significance of this condition. In addition to discuss recent research findings that may allow the development of more effective treatments.MethodsWe conducted a Medline and PubMed search using the search terms ‘sarcopenia’, ‘muscle’, ‘body composition’, ‘cirrhosis’, ‘liver’ and ‘malnutrition’ from inception to October 2015.ResultsCirrhotic patients with sarcopenia have reduced survival, experience increased rates of infection and have worse outcomes following liver transplantation. The aetiology of this condition is more complex than simple protein and calorie malnutrition. Cirrhosis also results in depleted glycogen stores and metabolic alterations that cause excessive protein catabolism, increased activation of the ubiquitin–proteasome pathway and inappropriate muscle autophagy. Satellite cell differentiation and proliferation is also reduced due to a combination of elevated myostatin levels, reducedIGF‐1 and hypogonadism. Although there is some evidence supporting the use of late evening snacks, branched chain amino acid supplementation and high protein/high calorie diets, well designed clinical trials addressing the effects of treatment on body composition in cirrhosis are lacking.ConclusionSarcopenia in cirrhosis has a complex pathogenesis and simple dietary interventions are insufficient. Improved understanding of the multiple mechanisms involved should allow the development of more effective therapies, which target the specific underlying metabolic derangements.

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References

93

[1]

10.1097/mcg.0000000000000208

[2]

10.1002/lt.23863

[3]

10.1016/j.nut.2014.07.005

[4]

Sinclair M "Low testosterone is a better predictor of mortality than sarcopenia in men with advanced liver disease" J Gastroenterol Hepatol (2015) 10.1111/jgh.12695

[5]

10.1007/s13539-012-0069-3

[6]

10.1046/j.1440-1746.2001.02487.x

[7]

10.3109/00365521.2013.777468

[8]

10.1111/apt.13156

[9]

10.1152/japplphysiol.91397.2008

[10]

10.1152/ajpendo.2001.280.3.e383

[11]

10.1016/j.hepres.2005.07.001

[12]

10.1016/j.ecl.2012.04.012

[13]

10.4161/auto.27918

[14]

10.1111/hepr.12085

[15]

10.1111/j.1440-1746.2008.05369.x

[16]

10.1002/hep.510260106

[17]

Romiti A "Malabsorption and nutritional abnormalities in patients with liver cirrhosis" Ital J Gastroenterol (1990)

[18]

10.1016/j.jhep.2012.11.023

[19]

10.1159/000356740

[20]

10.1038/sj.mt.6300182

[21]

10.1213/ane.0b013e3181eac1c9

[22]

10.1002/hep.27717

[23]

10.1073/pnas.1317049110

[24]

10.1016/j.jhep.2008.02.013

[25]

Zietz B "Dysfunction of the hypothalamic‐pituitary‐glandular axes and relation to Child‐Pugh classification in male patients with alcoholic and virus‐related cirrhosis" Eur J Gastro Hepatol (2003)

[26]

10.1210/en.2009-1177

[27]

10.1002/jcp.24298

[28]

10.1111/j.1440-1746.2011.06951.x

[29]

10.1172/jci111142

[30]

10.1016/s0899-9007(00)00567-0

[31]

10.1042/cs0780613

[32]

10.1152/japplphysiol.01042.2012

[33]

10.1093/ajcn/69.6.1194

[34]

Dam G "Muscle metabolism and whole blood amino acid profile in patients with liver disease" Scand J Clin Lab Invest (2015)

[35]

10.1093/jn/137.6.1579s

[36]

10.1007/s11011-012-9365-z

[37]

10.1016/j.nut.2014.03.016

[38]

Gluud LL "Branched‐chain amino acids for people with hepatic encephalopathy" Cochrane Database Syst Rev (2015)

[39]

10.1097/mco.0b013e32834dd297

[40]

10.1016/0016-5085(92)91122-k

[41]

10.1152/ajpendo.00186.2004

[42]

Testosterone dose-response relationships in healthy young men

Shalender Bhasin, Linda Woodhouse, Richard Casaburi et al.

American Journal of Physiology-Endocrinology and M... 10.1152/ajpendo.2001.281.6.e1172

[43]

10.1152/ajpendo.00402.2010

[44]

10.1111/j.1365-2265.1995.tb02040.x

[45]

10.1111/j.1365-2265.2012.04347.x

[46]

10.1016/j.mad.2008.08.001

[47]

10.1016/s0899-9007(96)00399-1

[48]

Loguercio C "Malnutrition in cirrhotic patients: anthropometric measurements as a method of assessing nutritional status" Brit J Clin Pract (1990) 10.1111/j.1742-1241.1990.tb10750.x

[49]

10.1016/j.ultrasmedbio.2015.04.004

[50]

Bassil N "The benefits and risks of testosterone replacement therapy: a review" Ther Clin Risk Manag (2009)

Showing 50 of 93 references

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Details

Published: Feb 05, 2016
Vol/Issue: 43(7)
Pages: 765-777
License: View

Authors

M

M. Sinclair

Liver Transplant Unit Austin Hospital Melbourne Vic. Australia; Department of Medicine The University of Melbourne Melbourne Vic. Australia

P

P. J. Gow

Liver Transplant Unit Austin Hospital Melbourne Vic. Australia; Department of Medicine The University of Melbourne Melbourne Vic. Australia

M

M. Grossmann

Endocrinology Unit Austin Hospital Melbourne Vic. Australia; Department of Medicine The University of Melbourne Melbourne Vic. Australia

P

P. W. Angus

Liver Transplant Unit Austin Hospital Melbourne Vic. Australia; Department of Medicine The University of Melbourne Melbourne Vic. Australia

Cite This Article

M. Sinclair, P. J. Gow, M. Grossmann, et al. (2016). Review article: sarcopenia in cirrhosis – aetiology, implications and potential therapeutic interventions. Alimentary Pharmacology & Therapeutics, 43(7), 765-777. https://doi.org/10.1111/apt.13549

Review article: sarcopenia in cirrhosis – aetiology, implications and potential therapeutic interventions

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