Abstract
Sarcopenia as a syndrome characterized by the progressive and generalized loss of skeletal muscle mass and strength that can lead to adverse outcomes, such as physical disability, poor quality of life, and death. The prevalence of malnutrition in chronic liver disease may range from 20% to 90%. Potentially all patients with cirrhosis are malnourished to some degree due to changes in nutrient ingestion, absorption, and utilization. Sarcopenia is common in liver transplant candidates and recipients and was associated with worse outcomes, including reduced survival. But it is of note that over - weigh or obesity does not exclude sarcopenia even in liver transplanted patients. The diagnosis of sarcopenia requires documentation of both low muscle mass and function. If possible, multidisciplinary, early intervention and aggressive treatment of nutrient deficiencies can prevent the physical downward trend that affects many patients with an advanced liver disease. Referral for transplant evaluation in appropriate patients should occur before the emergence of the clinical evidence of malnutrition. The degree of malnutrition allows the physicians to counsel the patient and family regarding the prognosis before and after transplantation. Frequent meals and nocturnal oral supplements represent a good nutritional strategy for cirrhotics, in order to decrease gluconeogenesis and protein catabolism.
Highlights
During the 19th and the early 20th centuries, cirrhosis in alcoholics was named nutritional cirrhosis, and the clinical approach was to provide the patients with high-quality protein calories as well as to encourage the maintenance of alcohol abstinence [1]
It is of note that sarcopenia is not synonymous to cachexia, but there is a concrete overlay between these disorders (Figure 1) [5]
The prevalence of malnutrition in chronic liver disease may range from 20% to 90% depending on the methods used for the nutritional assessment and the severity of liver disease [16]
Summary
During the 19th and the early 20th centuries, cirrhosis in alcoholics was named nutritional cirrhosis, and the clinical approach was to provide the patients with high-quality protein calories as well as to encourage the maintenance of alcohol abstinence [1]. It is calculated that 72.4% of patients with compensated hepatitis C virus (HCV) - related cirrhosis have an excess caloric intake [11], and 61% of them could have a body mass index (BMI) ≥ 25 kg/m2 [12] Both chronic HCV infections and being overweight / obesity can cause insulin resistance, which raises the risk of liver fibrosis progression and HCC occurrence in HCV-related cirrhotics [13,14]. Sarcopenic obesity and sarcopenia with normal or increased BMI are already recognized in various clinical conditions, including breast cancer patients with adjuvant chemotherapy, rheumatoid arthritis, and in most patients with COPD or chronic kidney disease [4] Not infrequently, it characterizes patients with a liver disease [15]. The challenge in cirrhotic patients, in general, is to achieve the goal of malnutrition prevention and possibly the minimization of the iatrogenic reasons of proper nutrition
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