Abstract
Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass and strength that occurs with aging or in association with various diseases. The condition is prevalent worldwide and occurs more frequently in patients with chronic diseases owing to the intrinsic relationship of muscles with glucose, lipid, and protein metabolism. Liver cirrhosis is characterized by the progression of necro-inflammatory liver diseases, which leads to fibrosis, portal hypertension, and a catabolic state, which causes loss of muscle tissue. Sarcopenia is of significant concern in the state of liver cirrhosis because sarcopenia has been associated with higher mortality, increased hospital admissions, worse post-liver transplant outcomes, decreased quality of life, and increased risk for other complications associated with cirrhosis. Therefore, sarcopenia is also an important feature of liver cirrhosis, representing a negative prognostic factor and influencing mortality. An increased understanding of sarcopenia could lead to the development of novel therapeutic approaches that could help improve the cognitive impairment of cirrhotic patients; therefore, we present a review of the mechanisms and diagnosis of sarcopenia in liver disease and existing therapeutic approaches.
Highlights
The ability of follistatin to prevent muscle wasting in cachexia and fibrosis in mouse models of muscular dystrophy probably involves interference with myostatin signaling via the pathway, the relative contributions of endogenous activin and myostatin have not been well characterized in these models [25,26,27]
In the context of liver disease, this involves an imbalance between plasma levels of free amino acids, and hypoproteinemia and hyperammonemia, as well as a negative nitrogen equilibrium resulting from abnormal protein/amino acid metabolism due to decreased efficiency of glucose use during the early morning fasting state [35]
One plausible mechanism of amino acid imbalance is that the decline in the detoxification function of the liver that occurs during cirrhosis is compensated by the inhibition of ammonia metabolism in the skeletal muscles, and branched-chain acids (BCAAs) are used as substrates in this process [40]
Summary
Older People 2 (EWGSOP2) updated the original definition to reflect scientific and clinical evidence that has accumulated over the last decade They reported that sarcopenia is indicated for cases with decreased skeletal muscle mass of the extremities in addition to decreased physical function (indicated by gait speed) or muscle strength (indicated by grip strength) [4]. Physical function declines with age as the balance between protein synthesis and degradation in the skeletal muscle becomes compromised. This reduces muscle strength, which can result in falls or gait disturbance [5]. We review the mechanisms and diagnosis of sarcopenia in liver disease and the existing and potential novel therapeutic approaches
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