Sarcopenia in chronic liver diseases

Abstract

Sarcopenia is aprogressive and generalized disorder of the skeletal musculature that involves the loss of skeletal muscle mass and function. Patients with chronic liver disease frequently have sarcopenia in advanced stages of the disease; however, there is an increased prevalence of sarcopenia not only in liver cirrhosis but also in earlier stages of disease, e.g., in non-alcoholic fatty liver disease (NAFLD). Sarcopenia is an independent prognostic risk factor for morbidity and mortality in patients with liver cirrhosis. The pathogenesis of sarcopenia is multifactorial and in chronic liver diseases alower oral energy intake, altered ammonia metabolism, hormonal imbalances and achronic low-grade inflammatory state are important. When the screening test is positive, determination of the muscle strength, e.g., measurement of hand grip strength, is recommended for the diagnostic approach. Lower muscle strength leads to further measurement of muscle mass to confirm the diagnosis of sarcopenia. In patients with chronic liver disease abdominal imaging by computed tomography or magnetic resonance imaging is particularly suitable for this. The severity of sarcopenia is classified by the physical performance. Therapeutic strategies for the treatment of sarcopenia include nutritional therapy as well as exercise therapy. Patients with chronic liver diseases frequently have sarcopenia. This is an independent prognostic risk factor. Therefore, sarcopenia should be considered in the diagnostics and therapeutic approaches.