Creatine Supplementation to Improve Sarcopenia in Chronic Liver Disease: Facts and Perspectives

Abstract

Creatine supplementation has been one of the most studied and useful ergogenic nutritional support for athletes to improve performance, strength, and muscular mass. Over time creatine has shown beneficial effects in several human disease conditions. This review aims to summarise the current evidence for creatine supplementation in advanced chronic liver disease and its complications, primarily in sarcopenic cirrhotic patients, because this condition is known to be associated with poor prognosis and outcomes. Although creatine supplementation in chronic liver disease seems to be barely investigated and not studied in human patients, its potential efficacy on chronic liver disease is indirectly highlighted in animal models of non-alcoholic fatty liver disease, bringing beneficial effects in the fatty liver. Similarly, encephalopathy and fatigue seem to have beneficial effects. Creatine supplementation has demonstrated effects in sarcopenia in the elderly with and without resistance training suggesting a potential role in improving this condition in patients with advanced chronic liver disease. Creatine supplementation could address several critical points of chronic liver disease and its complications. Further studies are needed to support the clinical burden of this hypothesis.

Nutritional Strategies for Muscle Atrophy: Current Evidence and Underlying Mechanisms

“…[45] Furthermore, creatine supplementation has proven effective for managing sarcopenia among older adults and may hold promise for ameliorating muscle wasting associated with chronic liver disease and cancer. [48][49][50] To concluded, amino acids and their associated substances can help to combat muscle atrophy by regulating energy metabolism and maintaining protein homeostasis. Additionally, leucine and HMB are often used alongside other nutrients, such as vitamins, for better outcomes.…”

From Listing to Recovery: A Review of Nutritional Status Assessment and Management in Liver Transplant Patients

“…At least 60% of cirrhotic patients awaiting LT are malnourished, mainly because of insufficient food intake [ 127 , 128 ]. Indeed, Ferreira et al demonstrated that a negative energy balance (obtained by subtracting total caloric intake from total energy expenditure), mostly due to inadequate food intake, was present in 78.1% of cirrhotic patients awaiting LT [ 129 ].…”

Osteosarcopenia in NAFLD/MAFLD: An Underappreciated Clinical Problem in Chronic Liver Disease

“…However, studies found high heterogeneity in BCAA dosage (6 to 110 g/day) and supplementation duration (3 to 12 months). Therefore, more research is needed to define the BCAA dosage and timing to prevent/treat sarcopenia in CLD patients, including the optimal combination of BCAA and resistance training to maximise the effect on muscle mass and function [ 237 ].…”