Sarcopenia in Liver Disease

  • Hiroki Nishikawa
  • Shuhei Nishiguchi


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.


Sarcopenia Liver Japanese guidelines Biomarkers Therapy 



Asian Working Group for Sarcopenia


Branched-chain amino acid


Bio-impedance analysis


Computed tomography


Hepatocellular carcinoma


Japan Society of Hepatology


The third lumbar level


Liver cirrhosis


Model for end-stage liver disease


Muscle mass decrease


Nonalcoholic fatty liver disease


Overall survival


Protein energy malnutrition


Psoas muscle index


Performance status


Randomized controlled trial



We gratefully thank all medical staff in our hospital.

Conflicts of Interest



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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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