Muscle wasting in advanced liver disease: from pathogenesis to therapeutic interventions

Abstract

Introduction. Muscle wasting or sarcopenia is a major component of malnutrition and occurs frequently in ad­vanced liver diseases, being an important prognostic factor and a predictor of mortality. However, in clinical practice, there are no well-established criteria for diagnosing this common complication of cirrhosis, the mechanisms in­volved are not fully understood and possible treatment op­tions are still being evaluated. Materials and method. To summarize the current state of knowledge, we searched the literature using the PubMed, Embase and Web of Science databases. Results. We selected 21 scientific pa­pers for this review. Muscle wasting or sarcopenia is a ne­ga­tive prognostic factor for mortality in patients with ad­vanced liver disease and an independent predictor of com­pli­ca­tions. The causes involved in this condition are much more complex than malnutrition and low protein intake, in­clu­ding changes in metabolic pathways that use amino acids and dietary lipids. Current guidelines recommend, in addition to moderate physical exertion, the intake of branched-chain amino acids (BCAAs), hormone therapies with testosterone and insulin-like growth factor (IGF-1) as potential therapeutic interventions. Conclusions. Old treat­ment recommendations that support physical exercise and a high-protein diet do not take into account the al­tered metabolic pathways that lead to muscle wasting in patients with advanced liver disease. Further research is needed to develop specific therapeutic methods.