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Nutrition and Muscle in Cirrhosis.
J Clin Exp Hepatol 2017; 7(4):340-357JC

Abstract

As the cirrhosis progresses, development of complication like ascites, hepatic encephalopathy, variceal bleeding, kidney dysfunction, and hepatocellular carcinoma signify increasing risk of short term mortality. Malnutrition and muscle wasting (sarcopenia) is yet other complications that negatively impact survival, quality of life, and response to stressors, such as infection and surgery in patients with cirrhosis. Conventionally, these are not routinely looked for, because nutritional assessment can be a difficult especially if there is associated fluid retention and/or obesity. Patients with cirrhosis may have a combination of loss of skeletal muscle and gain of adipose tissue, culminating in the condition of "sarcopenic obesity." Sarcopenia in cirrhotic patients has been associated with increased mortality, sepsis complications, hyperammonemia, overt hepatic encephalopathy, and increased length of stay after liver transplantation. Assessment of muscles with cross-sectional imaging studies has become an attractive index of nutritional status evaluation in cirrhosis, as sarcopenia, the major component of malnutrition, is primarily responsible for the adverse clinical consequences seen in patients with liver disease. Cirrhosis is a state of accelerated starvation, with increased gluconeogenesis that requires amino acid diversion from other metabolic functions. Protein homeostasis is disturbed in cirrhosis due to several factors such as hyperammonemia, hormonal, and cytokine abnormalities, physical inactivity and direct effects of ethanol and its metabolites. New approaches to manage sarcopenia are being evolved. Branched chain amino acid supplementation, Myostatin inhibitors, and mitochondrial protective agents are currently in various stages of evaluation in preclinical studies to prevent and reverse sarcopenia, in cirrhosis.

Authors+Show Affiliations

Indraprastha Apollo Hospital, New Delhi, India.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

29234200

Citation

Anand, Anil C.. "Nutrition and Muscle in Cirrhosis." Journal of Clinical and Experimental Hepatology, vol. 7, no. 4, 2017, pp. 340-357.
Anand AC. Nutrition and Muscle in Cirrhosis. J Clin Exp Hepatol. 2017;7(4):340-357.
Anand, A. C. (2017). Nutrition and Muscle in Cirrhosis. Journal of Clinical and Experimental Hepatology, 7(4), pp. 340-357. doi:10.1016/j.jceh.2017.11.001.
Anand AC. Nutrition and Muscle in Cirrhosis. J Clin Exp Hepatol. 2017;7(4):340-357. PubMed PMID: 29234200.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Nutrition and Muscle in Cirrhosis. A1 - Anand,Anil C, Y1 - 2017/11/08/ PY - 2017/10/25/received PY - 2017/11/02/accepted PY - 2017/12/14/entrez PY - 2017/12/14/pubmed PY - 2017/12/14/medline KW - (PG) SGA, patient-generated SGA KW - AMPK, 5′ adenosine monophosphate-activated protein kinase KW - ASPEN, American Society of Parenteral and Enteral Nutrition KW - ATP, adenosine triphosphate KW - Akt/PKB, serine/threonine-specific protein kinase B KW - BIA, bio-electric impedance analysis KW - BMC, bone mineral content KW - BMI, body mass index KW - CT, computed tomography KW - DDLT, deceased donor liver transplantation KW - DRM, disease-related malnutrition KW - DXA, dual X-ray absorptiometry KW - ESPEN, European Society of Parenteral and Enteral Nutrition KW - FFI, Fried Frailty Index KW - FFM, fat free mass KW - FFMI, fat free mass index KW - FM, fat mass KW - HE, hepatic encephalopathy KW - LDLT, living donor liver transplant KW - LST, lean soft tissue KW - MAC, mid arm circumference KW - MAMC, mid arm muscle circumference KW - MELD, model for end-stage liver disease KW - MNA, Mini Nutritional Assessment KW - MRI, magnetic resonance imaging KW - NASH, non-alcoholic steatohepatitis KW - PCM, protein-calorie nalnutrition KW - REE, resting energy expenditure KW - RQ, respiratory quotient (or RQ or respiratory coefficient) KW - SGA, Subjective Global Assessment KW - SMI, Skeletal Muscle Index KW - SPPB, Short Physical Performance Battery KW - TIPS, trans jugular intrahepatic portocaval shunts KW - TNF, tumour necrosis factor KW - TSF, triceps skin fild thickness KW - WHO, World Health Organisation KW - YPA, total psoas area KW - aKG, alfa keto glutarate KW - cirrhosis KW - mTORC1, mammalian target of rapamycin complex 1 KW - nutrition SP - 340 EP - 357 JF - Journal of clinical and experimental hepatology JO - J Clin Exp Hepatol VL - 7 IS - 4 N2 - As the cirrhosis progresses, development of complication like ascites, hepatic encephalopathy, variceal bleeding, kidney dysfunction, and hepatocellular carcinoma signify increasing risk of short term mortality. Malnutrition and muscle wasting (sarcopenia) is yet other complications that negatively impact survival, quality of life, and response to stressors, such as infection and surgery in patients with cirrhosis. Conventionally, these are not routinely looked for, because nutritional assessment can be a difficult especially if there is associated fluid retention and/or obesity. Patients with cirrhosis may have a combination of loss of skeletal muscle and gain of adipose tissue, culminating in the condition of "sarcopenic obesity." Sarcopenia in cirrhotic patients has been associated with increased mortality, sepsis complications, hyperammonemia, overt hepatic encephalopathy, and increased length of stay after liver transplantation. Assessment of muscles with cross-sectional imaging studies has become an attractive index of nutritional status evaluation in cirrhosis, as sarcopenia, the major component of malnutrition, is primarily responsible for the adverse clinical consequences seen in patients with liver disease. Cirrhosis is a state of accelerated starvation, with increased gluconeogenesis that requires amino acid diversion from other metabolic functions. Protein homeostasis is disturbed in cirrhosis due to several factors such as hyperammonemia, hormonal, and cytokine abnormalities, physical inactivity and direct effects of ethanol and its metabolites. New approaches to manage sarcopenia are being evolved. Branched chain amino acid supplementation, Myostatin inhibitors, and mitochondrial protective agents are currently in various stages of evaluation in preclinical studies to prevent and reverse sarcopenia, in cirrhosis. SN - 0973-6883 UR - https://www.unboundmedicine.com/medline/citation/29234200/Nutrition_and_Muscle_in_Cirrhosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0973-6883(17)30468-1 DB - PRIME DP - Unbound Medicine ER -