Sarcopenia in liver cirrhosis: Prevalence, pathophysiology and therapeutic strategies

Sarcopenia, characterized by a loss of muscle strength, quantity/quality, and physical performance is associated with increased mortality and poor clinical outcomes in concomitant presentation with liver cirrhosis (LC). A number of mechanisms are involved in sarcopenia development in LC, many of which are secondary to liver dysfunction and/or iatrogenic involvement in treating LC. Sarcopenia severity in this population appears to be affected by patient gender, as well as the primary aetiology of LC (alcohol, non-alcoholic fatty liver disease etc.) with patient demographics shifting in recent years. Clinical detection of sarcopenia in this population may involve a combination of assessment tools, in addition to measuring muscle mass and strength separately. Muscle mass may be assessed using radiography, bioelectric impedance, ultrasound, or anthropometrics. Hand-grip strength, on the other hand, may be a useful tool for evaluating muscle strength. The role of malnutrition in sarcopenia is also a relevant factor, and screening tools such as MELD and SARC-F may be clinically useful tools for more complete diagnosis of sarcopenia in these patients. Myostatin and titin-N may represent potential diagnostic biomarkers. Lastly, physical activity and nutrition remain key elements of treatment. Further research is being conducted regarding the role of resistance vs aerobic exercise as well as the function of complementary nutrition. Continued study into the role of nutrition, physical activity and other complementary therapies will be important future endeavours in the treatment of sarcopenia in LC.