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Sarcopenia in Liver Disease

  • Hiroki Nishikawa
  • Shuhei Nishiguchi
Chapter

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.

Keywords

Sarcopenia Liver Japanese guidelines Biomarkers Therapy 

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

Notes

Acknowledgments

We gratefully thank all medical staff in our hospital.

Conflicts of Interest

None.

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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Hiroki Nishikawa
    • 1
  • Shuhei Nishiguchi
    • 1
  1. 1.Division of Hepatobiliary and Pancreatic Disease, Department of Internal MedicineHyogo College of MedicineHyogoJapan

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