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Sarcopenia in Liver Disease

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The Evolving Landscape of Liver Cirrhosis Management

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Abstract

Because skeletal muscle is the largest store of proteins in the body, protein homeostasis is essential for the maintenance of skeletal muscle mass. Aging disrupts the balance between protein synthesis and breakdown in skeletal muscle, resulting in muscle strength decline, walking disorders, falls, and other problems. The decreased muscle mass and muscle strength that accompanies aging is defined as primary sarcopenia, while the decreased muscle mass and muscle strength that accompanies an underlying disease is defined as secondary sarcopenia. Several potential biomarkers associated with skeletal muscle mass loss have been reported. The most conceivable mechanism which can cause sarcopenia in patients with liver disease is protein energy malnutrition. Skeletal muscle mass is not only a good indicator of nutrition in patients with liver disease, but also has recently been shown to be closely related to survival in patients with liver disease. In 2016, the Japan Society of Hepatology established its own assessment criteria for sarcopenia in liver disease as the number of liver disease patients with sarcopenia is expected to increase and there is compelling evidence to indicate patients with sarcopenia have unfavorable clinical outcomes, and in subsequent several studies, its usefulness was validated. On the other hand, exercise and branched-chain amino acid supplementation may be recommended in sarcopenic patients with liver disease. Here, in this article, we will summarize the current knowledge of sarcopenia in liver disease.

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Abbreviations

AWGS:

Asian Working Group for Sarcopenia

BCAA:

Branched-chain amino acid

BIA:

Bio-impedance analysis

CT:

Computed tomography

HCC:

Hepatocellular carcinoma

JSH:

Japan Society of Hepatology

L3:

The third lumbar level

LC:

Liver cirrhosis

MELD:

Model for end-stage liver disease

MMD:

Muscle mass decrease

NAFLD:

Nonalcoholic fatty liver disease

OS:

Overall survival

PEM:

Protein energy malnutrition

PMI:

Psoas muscle index

PS:

Performance status

RCT:

Randomized controlled trial

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Acknowledgments

We gratefully thank all medical staff in our hospital.

Conflicts of Interest

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Authors and Affiliations

  1. Division of Hepatobiliary and Pancreatic Disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan

    Hiroki Nishikawa & Shuhei Nishiguchi

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  1. Hiroki Nishikawa
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  2. Shuhei Nishiguchi
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Editors and Affiliations

  1. Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan

    Hitoshi Yoshiji

  2. Third Department of Internal Medicine, Nara Medical University, Kashihara, Nara, Japan

    Kosuke Kaji

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Nishikawa, H., Nishiguchi, S. (2019). Sarcopenia in Liver Disease. In: Yoshiji, H., Kaji, K. (eds) The Evolving Landscape of Liver Cirrhosis Management. Springer, Singapore. https://doi.org/10.1007/978-981-13-7979-6_10

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  • DOI: https://doi.org/10.1007/978-981-13-7979-6_10

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