From the Guidelines
Preventing sarcopenia in liver cirrhosis requires a comprehensive approach focusing on nutrition and exercise, with a recommended protein intake of 1.2-1.5g per kilogram of body weight daily, and moderate-intensity exercise for 150 minutes per week, as supported by the most recent evidence 1. To address sarcopenia in liver cirrhosis, the following key points should be considered:
- Protein intake: 1.2-1.5g per kilogram of body weight daily, with emphasis on high-quality proteins like dairy, eggs, and lean meats, as recommended by recent guidelines 1.
- Branched-chain amino acid (BCAA) supplements: may be beneficial, especially for those with protein intolerance, although the optimal dosage is not well established.
- Exercise: moderate-intensity exercise, ideally for 150 minutes per week, including resistance training and aerobic exercise, as suggested by recent research 1.
- Frequent meals: eating frequent small meals, avoiding more than 4-6 hours between meals, and considering a bedtime snack with protein and complex carbohydrates, as recommended by experts 1.
- Consultation with a specialized nutritionist: preferred, given the complexity of nutritional needs in patients with liver cirrhosis and sarcopenia. The approach to preventing sarcopenia in liver cirrhosis should prioritize nutrition and exercise, as these interventions can counteract the metabolic abnormalities, reduced protein synthesis, and increased muscle breakdown associated with sarcopenia, while also supporting liver function, as highlighted by recent studies 1.
From the Research
Sarcopenia and Liver Cirrhosis Prevention
- Sarcopenia is a complex, multifactorial chronic condition characterized by reduced muscle mass and strength/function, which increases the risk of liver-related morbidity and mortality in patients with liver cirrhosis 2.
- The pathogenesis of sarcopenia in liver cirrhosis is complex and multifaceted, involving factors such as chronic catabolic conditions, increased energy expenditure, reduced appetite, and alterations in circulating levels of hormones 3.
- Early recognition and tailored management incorporating high protein diets and combination aerobic/resistance exercise can ameliorate the complications associated with sarcopenia in cirrhosis 2.
- Clinical detection of sarcopenia in liver cirrhosis may involve a combination of assessment tools, including radiography, bioelectric impedance, ultrasound, or anthropometrics, as well as measuring muscle mass and strength separately 4.
Prevention and Treatment Strategies
- Physical activity and nutrition remain key elements of treatment for sarcopenia in liver cirrhosis, with resistance and aerobic exercise, as well as complementary nutrition, being important components 4.
- Branched-chain amino acid (BCAA) supplementation has been found to improve several parameters used to assess sarcopenia in liver cirrhosis, including skeletal muscle index and mid-arm muscle circumference 5.
- Other potential therapeutic strategies for sarcopenia in liver cirrhosis include myostatin inhibition and the use of nutraceuticals such as Urolithin A 6.
- Late-evening snacks and BCAA supplementation have also been proposed as potential management and treatment strategies for sarcopenia in chronic liver disease 6.
Importance of Early Detection and Management
- Sarcopenia is associated with a higher rate of waitlist mortality, hepatic encephalopathy, and lower quality of life in patients with liver cirrhosis, highlighting the importance of early detection and management 3.
- Future studies should aim to unify and validate liver disease-specific cutoffs for the definition of sarcopenia, as well as investigate the role of nutrition, physical activity, and other complementary therapies in the treatment of sarcopenia in liver cirrhosis 4, 3.