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Clinical relevance of sarcopenia in patients with cirrhosis.

Abstract

The most commonly recognized complications in cirrhotic patients include ascites, hepatic encephalopathy, variceal bleeding, susceptibility for infections, kidney dysfunction, and hepatocellular carcinoma; however, severe muscle wasting or sarcopenia are the most common and frequently unseen complications which negatively impact survival, quality of life, and response to stressor, such as infections and surgeries. At present, D'Amico stage classification, Child-Pugh, and MELD scores constitute the best tools to predict mortality in patients with cirrhosis; however, one of their main limitations is the lack of assessing the nutritional and functional status. Currently, numerous methods are available to evaluate the nutrition status of the cirrhotic patient; nevertheless, most of these techniques have limitations primarily because lack of objectivity, reproducibility, and prognosis discrimination. In this regard, an objective and reproducible technique, such as muscle mass quantification with cross-sectional imaging studies (computed tomography scan or magnetic resonance imaging) constitute an attractive index of nutritional status in cirrhosis. Sarcopenia is part of the frailty complex present in cirrhotic patients, resulting from cumulative declines across multiple physiologic systems and characterized by impaired functional capacity, decreased reserve, resistance to stressors, and predisposition to poor outcomes. In this review, we discuss the current accepted and new methods to evaluate prognosis in cirrhosis. Also, we analyze the current knowledge regarding incidence and clinical impact of malnutrition and sarcopenia in patients with cirrhosis and their impact after liver transplantation. Finally, we discuss existing and potential novel therapeutic approaches for malnutrition in cirrhosis, emphasizing the recognition of sarcopenia in an effort to reduced morbidity related and improved survival in cirrhosis.

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  • Authors+Show Affiliations

    Aldo J Montano-Loza, Division of Gastroenterology and Liver Unit, University of Alberta Hospital, University of Alberta, Edmonton AB T6G 2X8, Canada.

    Source

    World journal of gastroenterology 20:25 2014 Jul 07 pg 8061-71

    MeSH

    Body Composition
    Diagnostic Imaging
    Disease Progression
    Humans
    Liver Cirrhosis
    Liver Transplantation
    Malnutrition
    Nutrition Assessment
    Nutritional Status
    Predictive Value of Tests
    Risk Factors
    Sarcopenia
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    25009378

    Citation

    Montano-Loza, Aldo J.. "Clinical Relevance of Sarcopenia in Patients With Cirrhosis." World Journal of Gastroenterology, vol. 20, no. 25, 2014, pp. 8061-71.
    Montano-Loza AJ. Clinical relevance of sarcopenia in patients with cirrhosis. World J Gastroenterol. 2014;20(25):8061-71.
    Montano-Loza, A. J. (2014). Clinical relevance of sarcopenia in patients with cirrhosis. World Journal of Gastroenterology, 20(25), pp. 8061-71. doi:10.3748/wjg.v20.i25.8061.
    Montano-Loza AJ. Clinical Relevance of Sarcopenia in Patients With Cirrhosis. World J Gastroenterol. 2014 Jul 7;20(25):8061-71. PubMed PMID: 25009378.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Clinical relevance of sarcopenia in patients with cirrhosis. A1 - Montano-Loza,Aldo J, PY - 2013/11/01/received PY - 2014/01/13/revised PY - 2014/03/12/accepted PY - 2014/7/11/entrez PY - 2014/7/11/pubmed PY - 2015/4/11/medline KW - Body composition KW - Cirrhosis KW - Liver transplantation KW - Lumbar skeletal muscle index KW - Malnutrition KW - Mortality KW - Prognosis KW - Sarcopenia SP - 8061 EP - 71 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 20 IS - 25 N2 - The most commonly recognized complications in cirrhotic patients include ascites, hepatic encephalopathy, variceal bleeding, susceptibility for infections, kidney dysfunction, and hepatocellular carcinoma; however, severe muscle wasting or sarcopenia are the most common and frequently unseen complications which negatively impact survival, quality of life, and response to stressor, such as infections and surgeries. At present, D'Amico stage classification, Child-Pugh, and MELD scores constitute the best tools to predict mortality in patients with cirrhosis; however, one of their main limitations is the lack of assessing the nutritional and functional status. Currently, numerous methods are available to evaluate the nutrition status of the cirrhotic patient; nevertheless, most of these techniques have limitations primarily because lack of objectivity, reproducibility, and prognosis discrimination. In this regard, an objective and reproducible technique, such as muscle mass quantification with cross-sectional imaging studies (computed tomography scan or magnetic resonance imaging) constitute an attractive index of nutritional status in cirrhosis. Sarcopenia is part of the frailty complex present in cirrhotic patients, resulting from cumulative declines across multiple physiologic systems and characterized by impaired functional capacity, decreased reserve, resistance to stressors, and predisposition to poor outcomes. In this review, we discuss the current accepted and new methods to evaluate prognosis in cirrhosis. Also, we analyze the current knowledge regarding incidence and clinical impact of malnutrition and sarcopenia in patients with cirrhosis and their impact after liver transplantation. Finally, we discuss existing and potential novel therapeutic approaches for malnutrition in cirrhosis, emphasizing the recognition of sarcopenia in an effort to reduced morbidity related and improved survival in cirrhosis. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/25009378/full_citation L2 - http://www.wjgnet.com/1007-9327/full/v20/i25/8061.htm DB - PRIME DP - Unbound Medicine ER -