L‐Carnitine Suppresses Loss of Skeletal Muscle Mass in Patients With Liver Cirrhosis

Abstract

Liver cirrhosis (LC) is a major cause of secondary sarcopenia. Sarcopenia makes the prognosis worse; thus, novel therapeutic options for sarcopenia in patients with LC are urgently required as they are currently limited. In this retrospective study, 158 patients with LC were screened, and 35 of those patients who were treated with L‐carnitine for more than 6 months and for whom skeletal muscle mass changes could be evaluated by computer tomography were enrolled. Of the 158 patients, 79 patients who did not receive L‐carnitine supplementation served as controls. Cases and controls were propensity score matched for age, sex, presence of hepatocellular carcinoma, and branched chain amino acid administration, and changes in skeletal muscle mass and clinical data were compared. The 35 patients who received L‐carnitine supplementation and 35 propensity score‐matched patients who did not receive carnitine supplementation comprised the final enrollment. Compared with control patients, patients who received L‐carnitine had significantly worse liver function, which is associated with rapid progress of skeletal muscle depletion. However, loss of skeletal muscle mass was significantly suppressed in patients receiving L‐carnitine, and a significant effect was observed in patient subgroups stratified by age, sex, presence of hepatocellular carcinoma, and branched chain amino acid administration. The change ratios of most laboratory data, including vitamin D and insulin‐like growth factor 1 levels, were similar in the two groups, but ammonia levels were significantly less in those receiving L‐carnitine. However, even in patients receiving L‐carnitine but not showing an ammonia decrease, loss of skeletal muscle was significantly suppressed. Conclusion: L‐carnitine suppresses loss of skeletal muscle mass and may therefore be a novel therapeutic option for sarcopenia in patients with LC. (Hepatology Communications 2018; 00:000‐000)

A North American Expert Opinion Statement on Sarcopenia in Liver Transplantation

“…Carnitine supplementation was recently reported to suppress muscle loss in an initial study of patients with cirrhosis. (46) Key poINtS 1. We believe sarcopenia should not be a sole criterion on which to determine candidacy for LT. 2.…”

Analysis of the optimal psoas muscle mass index cut‐off values, as measured by computed tomography, for the diagnosis of loss of skeletal muscle mass in Japanese people

“…Although controversy remains regarding the accuracy of BIA in patients with ascites, 6,12,13 the psoas muscle mass index (PMI), as assessed using CT, could be an ideal method for patients with chronic liver disease. The PMI is calculated as follows: the sum of the L3 level cross‐sectional area of the right and left psoas muscle mass as identified by manual tracing on CT imaging is divided by the height squared (cm 2 /m 2 ) 14 . With regard to liver disease, various reports have already evaluated skeletal muscle mass using PMI 9,14–18 .…”

Skeletal muscle mass is associated with toxicity, treatment tolerability, and additional or subsequent therapies in patients with hepatocellular carcinoma receiving sorafenib treatment

“…Several approaches, such as branched chain amino acid (BCAA) supplementation, BCAA supplementation and walking exercise, and L‐carnitine treatment, have been reported to prevent the development of skeletal muscle loss in patients with liver cirrhosis. In addition, previous studies have suggested that BCAA supplementation may be useful for maintaining hepatic functional reserve and may help to avoid early discontinuance of sorafenib therapy in patients with HCC receiving sorafenib treatment .…”